Consultation Form

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    I Am Seeking Info/Treatment for... : *

    Little interest or pleasure in doing things *

    OftenSometimesNever

    Feeling down, depressed or hopeless *

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    Trouble falling or staying asleep, or sleeping too much *

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    Feeling tired or having little energy *

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    Poor appetite or overeating *

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    feeling bad about yourself-or that you are a failure or let yourself or your family down Betternow_landing page *

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    Trouble concentrating on things, such as reading the newspaper or watching television *

    OftenSometimesNever

    Moving or speaking so slowly that other people could have noticed? Or so fidgety or restless that you have been moving a lot more than usual? *

    OftenSometimesNever

    Thoughts that you would be better off dead, or thoughts of hurting yourself in some way? *

    OftenSometimesNever