Please answer Yes or No to the following questions:		  Yes No
I feel sad most of the time
My mood alternates between extreme highs and lows
I feel irritable or on edge most of the time
I sleep too little or too much
(Indicate whether too little or too much)    
My appetite or weight has changed recently (w/o dieting)
My energy has decreased/increased
(Indicate whether increased or decreased)    
I find it increasingly difficult to concentrate
I frequently worry about minor matters
I’m less interested in most things
I have abused alcohol or drugs in the past 3 months
I have a family history of mental illness
     
 
 

If You Participate in a Clinical Trial, There is No Cost to You:

  • You receive study related medication and care at no-cost.
  • You receive $$$ in compensation, depending on the study and level of participation.
  • No reports are made to employers, schools or insurance companies. Our patient information is confidential .

I would like more information
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Home Phone :   (with area code)
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