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M E D I C W I S E
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Mental Screening
Mental Screening
Name
Email
Telephone Number
Age
Little interest or pleasure in doing things?
Not at all.
Several days.
More than half the days.
Nearly every day.
Feeling down, depressed, or hopeless?
Not at all.
Several days.
More than half the days.
Nearly every day.
Trouble falling or staying asleep, or sleeping too much?
Not at all.
Several days.
More than half the days.
Nearly every day.
Feeling tired or having little energy?
Not at all.
Several days.
More than half the days.
Nearly every day.
Poor appetite or overeating?
Not at all.
Several days.
More than half the days.
Nearly every day.
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M E D I C W I S E
The first aid to your invisible wounds. Together we feel, vent and heal.