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Do you have a prior diagnosis?*
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Your Age*
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What are your expectations from your therapist? A theripist who...*
Rate your current physical health*
Rate your eating habits*
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Little Interest or pleasure in doing things.*
Feeling down, depressed or hopeless.*
Trouble falling asleep, staying asleep, or sleeping too much.*
Feeling tired or having little energy*
Poor appetite or overeating*
Feeling like you're a failure or that you've let your family down.*
Trouble concentrating on things*
Thoughts that you would be better off dead or hurting yourself in some way.*
Are you currently employed?*
How often do you consume alcohol?*
When is the last time you considered suicide?*
Are you currently on any medications?*