Please rate each symptom on the scale. Note that some of the items have the scale in reverse order. (9 might be good or bad depending on the symptom.)

1. 

Depressed Mood


2. 

Interest in Activities


3. 

Energy Level


4. 

Appetite


5. 

Sleep (put the number of hours in the comment section


6. 

Hope


7. 

Self-esteem


8. 

Self-doubt


9. 

Guilt


10. 

Anger


11. 

Restlessness


12. 

Concentration


13. 

Indecisiveness


14. 

Irritability


15. 

Anxiety


16. 

Racing Thoughts


17. 

Worry


18. 

Discouragement


19. 

Paranoia


20. 

Suicidal Thoughts (Please explain below if this is not "none".)



Thank you for finishing this checklist. I look forward to discussing the results with you.

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(817) 946-1620 | carrie@carrienet.com | Licensed Online Therapy and Counseling

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