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Depression Index
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Depression Index
Depression Index
If you have any questions about this form, our staff is available during regular business hours (Mon – Fri, 8am – 5pm) to assist. Call us at 1-855-481-9605.
Your Name
(Required)
First
Last
Your Email Address
(Required)
Phone
(Required)
In the last 2 weeks, have you experienced:
Little interest or pleasure in doing things?
(Required)
Not at all
Several days
More than half the days
Nearly every day
Feeling down, depressed, or hopeless?
(Required)
Not at all
Several days
More than half the days
Nearly every day
Trouble falling or staying asleep, or sleeping too much?
(Required)
Not at all
Several days
More than half the days
Nearly every day
Feeling tired or having little energy?
(Required)
Not at all
Several days
More than half the days
Nearly every day
Poor appetite or overeating?
(Required)
Not at all
Several days
More than half the days
Nearly every day
Feeling bad about yourself — or that you are a failure or have let yourself or your family down?
(Required)
Not at all
Several days
More than half the days
Nearly every day
Trouble concentrating on things, such as reading the newspaper or watching television?
(Required)
Not at all
Several days
More than half the days
Nearly every day
Moving or speaking so slowly that other people could have noticed? Or so fidgety or restless that you have been moving a lot more than usual?
(Required)
Not at all
Several days
More than half the days
Nearly every day
Thoughts that you would be better off dead, or thoughts of hurting yourself in some way?
(Required)
Not at all
Several days
More than half the days
Nearly every day
How difficult have these problems made it to do work, take care of things at home, or get along with other people?
(Required)
Not at all
Somewhat difficult
Very difficult
Extremely difficult
Δ
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Home
About
About Mind Body Centers
Getting Started
Patient Testimonials
Ketamine Infusion Pricing
Hero Discount
Mind Body Centers Team
Services
Ketamine Infusion Therapy
Getting Started
Depression Treatment
Pain Treatment
PTSD Treatment
Anxiety Treatment
OCD Treatment
Suicidality Treatment
Mind
Counseling
Hypnotherapy & Guided Imagery
Body
IV Hydration
Nutrition
FAQ
Blog
Locations
Burnsville, Minnesota
Gilbert, Arizona
Contact
Patient Portal