Over the last 2 weeks, how often have you been bothered by any of the following problems? First NameLast NameDOB (dd/mm/yyyy)Post Code1. Little interest or pleasure in doing things Not at all Several days More Than Half the Days Nearly Every Day2. Feeling down, depressed or hopeles Not at all Several days More Than Half the Days Nearly Every Day3. Trouble falling or staying asleep, or sleeping too much Not at all Several days More Than Half the Days Nearly Every Day4. Feeling tired or having little energy Not at all Several days More Than Half the Days Nearly Every Day5. Poor appetite or overeating Not at all Several days More Than Half the Days Nearly Every Day6. Feeling bad about yourself - or that you are a failure or have let yourself or your family down Not at all Several days More Than Half the Days Nearly Every Day7. Trouble concentrating on things, such as reading the newspaper or watching television Not at all Several days More Than Half the Days Nearly Every Day8. Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual Not at all Several days More Than Half the Days Nearly Every Day9. Thoughts that you would be better off dead or of hurting yourself in some way Not at all Several days More Than Half the Days Nearly Every DayPlease check you have answered EVERY question. Thank you.