Name* First Last Mobile Number*We would like to know how you are feeling. Please check the answer that comes closest to how you have felt IN THE PAST 7 DAYS, not just how you feel today. In the past 7 days: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 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 Hiddensubsid HiddenEnglish HiddenMember HiddenDate MM slash DD slash YYYY Δ
