Are they sleeping more or less than usual?

Sleeping too much

Sleeping too little

About the Same

Are they eating more or less than usual?

Eating more

Eating less

About the same

If you were to described your loved one's energy, which of these would best describe them?

Exhausted

Energetic

About the same

How is their personal grooming routine?

They are struggling to maintain their usual routine.

They are obsessed with their appearence.

About the same

Thinking about the things they enjoy, how often are they participating in those activities?

Rarely

Occasionally

Often

Do they seem worried or irritable a lot?

Yes

No

Unsure

Do you notice an increase in consumption of substances? Food, drugs, alcohol?

Consuming more

Consuming less

About the same or unsure

Where should we send your results?

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