Depression Screening
Answers marked with a * are required.
Quick Depression Screening
  This survey is 100% Confidential. ONLY Dr. Rodman will see your responses and contact information.
 
​Do you take little interest or pleasure in doing things you once enjoyed? *
      
 
 
 
How often do you feel depressed, down, or hopeless?
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How often do you have trouble falling asleep, staying asleep, or sleeping too much?
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How often do you feel tired, lethargic, or have very little energy?
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How often during the last year have you had difficulty with over eating OR had little to no appetite?
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How often in the last year have you felt like you were a failure and/or a disappointment to those close to you?
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How often has your mood impacted your ability to focus on simple daily living tasks?
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Has your mood impacted you to such an extent that others notice you speaking, moving, and reacting more slowly OR being so restless that you can't sit still for any length or time?
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Have you ever harmed yourself through cutting or considered harming yourself or thought you would be better off dead?
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Have the problems and difficulties you considered above made it more difficult for you to function at work, home, school, or in relationships with other people?
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Please share with Dr. Rodman anything else you think would be helpful:
 
 
 
Once you have answered all of the questions, please enter your contact information and click submit.  Dr. Rodman will contact you personally to discuss your results. *
First Name:
Email:
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Age:
Gender:
 
 
 
 
 

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