These questions concern how you have been feeling over the past 30 days. Tick a box below each question that best represents how you have been . Name * First Name Last Name During the last 30 days, about how often did you feel tired out for no good reason? * 1. None of the time 2. A little of the time 3. Some of the time 4. Most of the time 5. All of the time During the last 30 days, about how often did you feel nervous? * 1. None of the time 2. A little of the time 3. Some of the time 4. Most of the time 5. All of the time During the last 30 days, about how often did you feel so nervous that nothing could calm you down? * 1. None of the time 2. A little of the time 3. Some of the time 4. Most of the time 5. All of the time During the last 30 days, about how often did you feel hopeless? * 1. None of the time 2. A little of the time 3. Some of the time 4. Most of the time 5. All of the time During the last 30 days, about how often did you feel restless or fidgety? * 1. None of the time 2. A little of the time 3. Some of the time 4. Most of the time 5. All of the time During the last 30 days, about how often did you feel so restless you could not sit still? * 1. None of the time 2. A little of the time 3. Some of the time 4. Most of the time 5. All of the time During the last 30 days, about how often did you feel depressed? * 1. None of the time 2. A little of the time 3. Some of the time 4. Most of the time 5. All of the time During the last 30 days, about how often did you feel that everything was an effort? * 1. None of the time 2. A little of the time 3. Some of the time 4. Most of the time 5. All of the time During the last 30 days, about how often did you feel so sad that nothing could cheer you up? * 1. None of the time 2. A little of the time 3. Some of the time 4. Most of the time 5. All of the time During the last 30 days, about how often did you feel worthless? * 1. None of the time 2. A little of the time 3. Some of the time 4. Most of the time 5. All of the time Thank you! Have a lovely day
