QIDS
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Birthday *
MM
/
DD
/
YYYY
Your First Name *
Filled out by *
CHECK THE ONE RESPONSE TO EACH ITEM THAT BEST DESCRIBES YOU FOR THE PAST SEVEN DAYS.
During the past 7 days...
Falling asleep *
Sleep during the night *
Waking up too early *
Sleeping too much *
Feeling Sad *
Decreased appetite *
Increased appetite *
(Within the last 2 weeks) Decreased weight
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(Within the last 2 weeks) Increased weight
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In the past 7 days...
Concentration/Decision making *
View of Myself *
Thoughts of Death or Suicide *
General Interest *
Energy Level *
Feeling Slowed Down *
Feeling Restless *
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