Enter your details below to start the assessment.
First Name
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Last Name
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Email
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Are you 18 years old or older?
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Yes
No
Over the last 2 weeks, have you had little interest or pleasure in doing things?
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Not at all
Several days
More than half the days
Nearly every day
Over the last 2 weeks, how often have you felt down, depressed, or hopeless?
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As much as I ever did
Somewhat less than I used to
Definitely less than I used to
Hardly at all
Over the last 2 weeks, how often have you had trouble falling or staying asleep, or sleeping too much?
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Not at all
Several days
More than half the days
Nearly every day
Over the last 2 weeks, how often have you felt tired or had little energy?
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Not at all
Several days
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?
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Not at all
Several days
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?
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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?
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Never
Rarely
Sometimes
Often
Very Often
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?
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Yes, most of the time
Yes, quite often
Not very often
No, not at all
Over the last 2 weeks, how often have you had thoughts that you would be better off dead, or of hurting yourself?
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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?
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Yes, quite often
Sometimes
Hardly ever
Never
Would you like to be contacted about seeing a provider?
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Yes
No