Date(Required)Email(Required) Mother's Name(Required) First Last Child's Name(Required) First Last 1. I have been able to laugh and see the funny side of things As much as I always could Not quite so much now Definitely not so much now Not at all 2. I have looked forward with enjoyment to things As much as I ever did Rather less than I used to Definitely less than I used to Hardly at all 3. I have blamed myself unnecessarily when things went wrong Yes, most of the time Yes, some of the time Not very often No, never 4. I have been anxious or worried for no good reason No, not at all Hardly ever Yes, sometimes Yes, very often 5. I have felt scared or panicky for no very good reason Yes, quite a lot Yes, sometimes No, not much No, not at all 6. Things have been getting on top of me Yes, most of the time I haven’t been able to cope at all Yes, sometimes I haven’t been coping as well as usual No, most of the time I have coped quite well No, I have been coping as well as ever 7. I have been so unhappy that I have had difficulty sleeping Yes, most of the time Yes, sometimes Not very often No, not at all 8. I have felt sad or miserable Yes, most of the time Yes, quite often Not very often No, not at all 9. I have been so unhappy that I have been crying Yes, most of the time Yes, quite often Only occasionally No, never 10. The thought of harming myself has occurred to me Yes, quite often Sometimes Hardly ever Never CAPTCHA
