Behavioral Health Consultants

 

Behavioral Health Consultants, LLC.

3018 Dixwell Avenue
Hamden, CT 06518

Toll Free:
1-800-864-2742
Local:
(203) 288-3554
Fax:
(203) 281-0235

Physicians Referral Form

DEPRESSION QUESTIONANIRE

Please answer True (T) or False (F) to the following questions based on how you have felt over the past two (2) weeks:

I feel sad most of the time. 

F

I have thoughts of hurting myself.

F

I have difficulty concentrating.  

F

I have no interest in activities I used to enjoy.

F

I have difficulty sleeping. 

F

There has been a big change in my eating habits. 

F

I feel worthless. 

F

I feel helpless.

F

I have no energy and feel tired all the time.;

F

I feel guilty most of the time.

F

 

If you answered True (T) to 5 or more of the above questions, then you may be experiencing some form of depression and should consider consulting with your EAP or local mental health professional for further evaluation and possible treatment.

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