This questionnaire measures various general behavioral health symptoms.

Please fill out all required fields and click the "Submit" button at the end of the questionnaire. 

Following completion, an email will be sent to you with results and how to follow up.

Over the last two weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Trouble falling or staying asleep
Sleeping too much
Feeling tired or having little energy
Poor appetite
Overeating
Feeling bad about yourself; feel like a failure
Trouble concentrating on things (such as reading)
Moving or speaking noticeably slower
Moving or speaking noticeably faster
Thoughts that you'd be better off dead
Thoughts about hurting yourself in some way
Feeling nervous, anxious, or on edge
Not being able to stop or control worrying
Worrying too much about different things
Trouble relaxing
Being so restless that it's hard to sit still
Becoming easily annoyed or irritable
Feeling afraid as if something awful might happen
Are you currently in any physical pain?
Have had nightmares about it or thought about it when you did not want to?
Tried hard not to think about it or went out of your way to avoid situations that remind you of it?
Were constantly on guard, watchful, or easily startled?
Felt numb or detached from others, activities, or your surroundings?

In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you:

Drinking alcohol affects your health. This is especially important if you take certain medications. We want to help you stay healthy and lower your risk for the problems that can be caused by drinking alcohol. 

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How often during the last year have you...

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© 2018 Refined Transitions

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San Diego, CA 92121