Assessment Form

1. During the past month, how much of the time were you a happy person?
2. How much of the time, during the past month, have you felt calm and peaceful?
3. How much of the time, during the past month, have you been a very nervous person?
4. How much of the time, during the past month, have you felt downhearted and blue?
5. How much of the time, during the past month, have you felt so down in the dumps that nothing could cheer you up?