1. Feeling nervous, anxious or on edge
(Required)
Not at all
Several days
More than half the days
Nearly every day
This field is required.
2. Not being able to stop or control worrying
(Required)
Not at all
Several days
More than half the days
Nearly every day
This field is required.
3. Feeling down, depressed or hopeless
(Required)
Not at all
Several days
More than half the days
Nearly every day
This field is required.
4. Little interest or pleasure in doing things
(Required)
Not at all
Several days
More than half the days
Nearly every day
This field is required.
Name
(Required)
First
Last
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Email
(Required)
This field is required.
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First two question score
Hidden
Last two question score
Hidden
Total Score
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