Mental Health

What is your Name?

What is your age?

16-20

21-24

25-30

31-44

45-50

50+

Tell me about your sleeping habits over the past 2 months. Have you noticed any changes?

Difficulty sleeping

Restlessness

Peaceful Sleep

Stressed

How frequently have you had little pleasure or interest in the activities you usually enjoy?

Never Sometimes/rarely While doing the activity

How frequently have you been bothered by not being able to stop worrying?

Always During panic situations Never