Over the last 2 weeks, how often have you been bothered by:
Little interest or pleasure in doing things
Over the last 2 weeks, how often have you been bothered by:
Feeling down, depressed, or hopeless
Over the last 2 weeks, how often have you been bothered by:
Trouble falling/staying asleep (without sleep medications), sleeping too much
Over the last 2 weeks, how often have you been bothered by:
Feeling tired or having little energy
Over the last 2 weeks, how often have you been bothered by:
Poor appetite or overeating
Over the last 2 weeks, how often have you been bothered by:
Feeling bad about yourself of that you are a failure or have let yourself or family down
Over the last 2 weeks, how often have you been bothered by:
Trouble concentrating on things, such as reading the newspaper or watching television
Over the last 2 weeks, how often have you been bothered by:
Moving or speaking so slowly that other people could have noticed. Or the opposite; being so fidgety or restless that you have been moving around a lot more than usual
Over the last 2 weeks, how often have you been bothered by:
Thoughts that you would be better off dead or of hurting yourself in some way
If you checked off any problem on this questionnaire so far, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
Have you had unsatisfactory results from:
May we contact you regarding TMS?
