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Self Check-In

This questionnaire will ask you about your overall wellbeing and some other related issues. Please complete these questions to help us understand your needs.

About how often did you feel tired out for no good reason?

About how often did you feel nervous?

About how often did you feel so nervous that nothing could calm you down?

About how often did you feel hopeless?

About how often did you feel restless or fidgety?

About how often did you feel so restless you could not sit still?

About how often did you feel depressed?

About how often did you feel that everything was an effort?

About how often did you feel so sad that nothing could cheer you up?

About how often did you feel worthless?

Have you bet more than you could really afford to lose?

Have you ever felt you ought to cut down on your drinking or drug use?

Have people annoyed you by criticizing your drinking or drug use?

Have you felt bad or guilty about your drinking or drug use?

Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?

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