How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?

Rate as: 

Not difficult __    at all … Somewhat difficult … Very difficult … Extremely difficult …

Over the last Four (4) weeks, how often have you been bothered by any of the following problems? (Use a score of 0-3 to indicate your answer). 

Scoring -  0 1 2 3 

0-Not at all

1-Several Times

2-More than half the Days

3-Nearly Every Day

1. Little or No Pleasure in DoingThings -  ___

2. Severe Anxiety - ___

3. Feeling Down, Depressed or Hopeless  -___

4. Severe Depression -___

5. Trouble Falling Asleep or Sleeping Too Much -___

6. Severe Life Crisis, Seems no way out -___

7. Severely Dysfunctional Family -___

8. Low Self Esteem - ___

9. Feeling Tired, Having Little Energy -___

10. Don’t know how to go on -___

11. Poor Appetite or Overeating - ___

12. Wonder if you have ADHD (Attention Deficit Hyper Activity) -___

13. Hurt, Angry, in Pain, Confused over a Divorce - ___

14. Feel Bad about Yourself or that you are a Failure or have Let Yourself or your Family Down -___

15. Feel you may have Asperger’s Syndrome -___

16. Have Few or No Friends/Feel like you just Don’t Fit in -___

17. Trouble Concentrating on things, such as Reading, Conversations or Watching TV Shows -___

18. Often Bullied or Embarrassed - ___

19. Bothered by a Difficult or Painful Childhood - ___

20. Wonder if you may be Bi-Polar -  ___

21. Get Angry Quickly -___

22. Drinking or Using Drugs to Dull your Pain -___

23. Shoplifting Even though you could afford to Pay - ____

24. Lying comes very easy for you -____

26. Are Experiencing Dysphoria –___

27. Wonder if you may  have Autism -___

28. Thoughts of Hurting Yourself in some way or that you would be Better off Dead? -___

29. Feelings of Not Being Good Enough, a Waste of Space -___

30. You are aware that Some Things come Ridiculously Easy for you - ___

31. Realize you have Unique Talents that most do not have - ___

FOR OFFICE CODING 0 + ______ + ______ + ______ =Total     Score: ____

If you scored less than 30, you likely have your mental health in fairly good order most often.  Come to an outing in your area to maintain and enjoy. 

If you scored 30 - 50, you will benefit enjoy one of our outings and you are probably doing a pretty good job looking after your mental health needs but may benefit from 1 - 2 visits. 

If you scored 50 or higher, and feel as you are experiencing difficult or extremely difficult challenges, you may benefit from our Program. 

Call or Text Today, for your FREE, Completely Confidential, No Obligation, 1/2 Hour Consultation.

(604) 799-7456

No question is silly, too big or too small. 

No Credit Card or Payment required for FREE Consultation

*Depending on your phone plan,  charges may apply