This brief questionnaire helps us understand how you have been feeling recently. It focuses on your mood, energy levels, and overall well-being over the past two weeks. Your responses provide valuable context for our team at Peninsula Psychology, ensuring we can offer the most appropriate and tailored support during your sessions.
Important: This questionnaire is a screening tool, not a diagnostic instrument. Completing this form does not substitute for a comprehensive clinical evaluation by a licensed professional. If you are experiencing a mental health emergency, feeling entirely overwhelmed, or having thoughts of self-harm, please do not wait for us to review this form. Immediately call 999, go to the nearest emergency room, or reach out to your local crisis support service.
Over the last 2 weeks, how often have you been bothered by any of the following problems?
This field is required
Your response has been recorded