EmailMe Form - THE HANDS DEPRESSION SCREENING

Over the past two weeks, how often have you:

	None or little of the time (0)	Some of the time (1)	Most of the time (2)	All of the time (3)
been feeling low in energy, slowed down?
been blaming yourself for things?
had poor appetite ?
had difficulty falling asleep, staying asleep?
been feeling hopeless about the future?
been feeling blue?
been feeling no interest in things?
had feelings of worthlessness?
thought about or wanted to commit suidice?
had difficulty concentrating or making decisions?

SCORING INSTRUCTIONS
1) Put a number (0 to 3) in the score column for each question using the guide below:
None or little of the time = 0
Some of the time = 1
Most of the time = 2
All of the time = 3
2. Add the numbers in the score column and record the total below.

Would you like Dr. Pinjala to contact you regarding these results?

Yes

No

Name

First Last

Email

Phone

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