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Depression Quiz
Main Menu
Psychiatry
Medication Management
What We Treat
TMS treatment
Spravato
Resources
Patients
Blogs
FAQ
Psychiatry FAQ
TMS FAQ
Spravato FAQ
About Us
Contact Us
Emergency Contacts
Physician Referrals
Self-Assessment Quiz
Step
1
of
3
- Answer Depression Quiz Questions
33%
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 the opposite being so fidgety or restless that you have been moving around 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 of hurting yourself in some way?
(Required)
Not at all
Several days
More than half the days
Nearly every day
If 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 poeple?
(Required)
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
Are You Currently Experiencing Symptoms of Depression? Select all that apply:
(Required)
Sadness
Low Energy & Motivation
Poor Concentration
Appetite Changes
Irritability
Trouble Sleeping
Other
Select All
Have You Been Clinically Diagnosed With Depression?
(Required)
Yes
No
What Type Of Insurance Do You Have?
(Required)
Private Insurance
Employer-Provided Insurance
Medicare
None. I Plan To Pay Myself
Are you taking medication to treat your depression?
(Required)
Yes
No
Are you still depressed despite your medication?
(Required)
Yes
No
Have you switched medications more than once due to side effects?
(Required)
Yes
No
Are depression symptoms interfering with your leisure activities, your relationships with your family and friends or your ability to work?
(Required)
Yes
No
First Name
(Required)
Last Name
Email Address
(Required)
Phone Number
(Required)
Where Are You Located?
(Required)
Who are you taking this assessment for?
Select ---
Myself
Mom
Dad
Friend
Other
How long you (or they) have been suffering from depression?
Select ---
1 Month
3 Month
6 Month
1 Year
3 Year
+5 Year
Age
Gender
Select ---
Male
Female
Custom
Have you ever been diagnosed with bipolar, schizophrenia, or other psychotic illnesses
Select ---
Yes
No
How many antidepressant medications have you tried?
Select ---
One
Two
Three
Four
Five
Have you tried counseling before? *
Select ---
Yes
No
Has your doctor ever used medications other than antidepressants to help you feel better?
Select ---
Yes
No
Are you suffering from any conditions listed below?
Anxiety
Anger
Attention
Communication
Concentration
Depression
Drugs/Alcohol
Eating Disorder
Hypersomnia
Insomnia
Nightmare
Nausea
Other Sleep Disorder
Phobia
Trusting Others
Worry
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