Mental Health Review Your Contact DetailsTitlePlease selectMrMrsMissMsName First Last Date of Birth DD slash MM slash YYYY Contact NumberAddress Street Address Address Line 2 City County / State / Region Post Code QuestionnaireOver the last two weeks, how often have you been bothered by any of the following problems?Little interest or pleasure in doing thingsPlease selectNot at allSeveral daysMore than half the dayNearly every dayFeeling down, depressed, or hopelessPlease selectNot at allSeveral daysMore than half the dayNearly every dayTrouble falling or staying asleep, or sleeping too muchPlease selectNot at allSeveral daysMore than half the dayNearly every dayFeeling tired or having little energyPlease selectNot at allSeveral daysMore than half the dayNearly every dayPoor appetite or overeatingPlease selectNot at allSeveral daysMore than half the dayNearly every dayFeeling bad about yourself, or that you are a failure or have let yourself or your family downPlease selectNot at allSeveral daysMore than half the dayNearly every dayTrouble concentrating on things, such as reading the newspaper or watching televisionPlease selectNot at allSeveral daysMore than half the dayNearly every dayMoving or speaking so 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 usualPlease selectNot at allSeveral daysMore than half the dayNearly every dayThoughts that you would be better off dead, or of hurting yourself in some wayPlease selectNot at allSeveral daysMore than half the dayNearly every dayFinallyIf you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?Please selectNot at allSeveral daysMore than half the dayNearly every day