Mood Quiz

1

Choose the best answer for how you have felt over the past week

2

Are you basically satisfied with your life? * This field is required.

YesNo

3

Have you dropped many of your activities and interests? * This field is required.

YesNo

4

Do you feel that your life is empty? * This field is required.

YesNo

5

Do you often get bored? * This field is required.

YesNo

6

Are you in good spirits most of the time? * This field is required.

YesNo

7

Are you afraid that something bad is going to happen to you? * This field is required.

YesNo

8

Do you feel happy most of the time? * This field is required.

YesNo

9

Do you often feel helpless? * This field is required.

YesNo

10

Do you prefer to stay at home, rather than going out and doing new things? * This field is required.

YesNo

11

Do you feel you have more problems with memory than most? * This field is required.

YesNo

12

Do you think it is wonderful to be alive now? * This field is required.

YesNo

13

Do you feel worthless the way you are now? * This field is required.

YesNo

14

Do you feel full of energy? * This field is required.

YesNo

15

Do you feel that your situation is hopeless? * This field is required.

YesNo

16

Do you think that most people are better off than you are? * This field is required.

YesNo

17

ScoreIf your score is 6 or more, it may mean that you have depression - you should tell your doctor.

18

Email* This field is required.We will send a copy of your quiz to the email address provided below

example@example.com

19

Name* This field is required.By typing your name and submitting your data, you acknowledge agreement to the Terms and Conditions found on the Modiin Neurology Clinic website (www.modiinneurology.com)

First Name

Last Name