Enter your details below to start the assessment.

First Name *

Last Name *

Email *

Are you 18 years old or older? *

Yes

Over the last 2 weeks, have you had little interest or pleasure in doing things? *

Not at all

Several days a week

More than half the days

Nearly every day

Over the last 2 weeks, how often have you felt down, depressed, or hopeless? *

Not at all

Several days a week

More than half the days

Nearly every day

Over the last 2 weeks, how often have you had trouble falling or staying asleep, or sleeping too much? *

Not at all

Several days a week

More than half the days

Nearly every day

Over the last 2 weeks, how often have you felt tired or had little energy? *

Not at all

Several days a week

More than half the days

Nearly every day

Over the last 2 weeks, how often have you had a poor appetite or have been overeating? *

Not at all

Several days a week

More than half the days

Nearly every day

Over the last 2 weeks, how often have you felt bad about yourself, or that you are a failure or have let yourself or your family down? *

Not at all

Several days a week

More than half the days

Nearly every day

Over the last 2 weeks, how often have you had trouble concentrating on things, such as reading the newspaper or watching television? *

Not at all

Several days a week

More than half the days

Nearly every day

Over the last 2 weeks, how often have your been moving or speaking slowly that other people could have noticed, or the opposite - being so fidgety or restless that you have been moving around a lot more than usual? *

Not at all

Several days a week

More than half the days

Nearly every day

Over the last 2 weeks, how often have you had thoughts that you would be better off dead, or of hurting yourself? *

Not at all

Several days a week

More than half the days

Nearly every day

If you checked off any problems, how difficult have these problems made it for you at work, home, or with other people? *

Not difficult at all

Somewhat difficult

Very difficult

Extremely difficult

Would you like to be contacted about seeing a provider? *

Yes