Survey PHQ-9 Email Address(Required) Your email address will be stored as a random string of letters and number as soon as you submit this form using a hashing algorithm. The is no way to reverse engineer your email address back out. This is only used to connect this entry to any past of future entries for the purposes of statistical analysis. We will not be able to see who submitted this form and there is no possible way for us to extrapolate that information.Have you attended a Crux Wilderness Therapy clinic in the past?(Required) Yes No Over the last two weeks how often have you been bothered by any of the following problems?Little interest or pleasure in doing things(Required) 0 | Not at all 1 | Several Days 2 | More than half of the days 3 | Nearly all of the days Feeling down, depressed, or hopeless(Required) 0 | Not at all 1 | Several Days 2 | More than half of the days 3 | Nearly all of the days Trouble falling or staying asleep, or sleeping too much(Required) 0 | Not at all 1 | Several Days 2 | More than half of the days 3 | Nearly all of the days Feeling tired or having little energy(Required) 0 | Not at all 1 | Several Days 2 | More than half of the days 3 | Nearly all of the days Poor appetite or overeating(Required) 0 | Not at all 1 | Several Days 2 | More than half of the days 3 | Nearly all of the days Feeling bad about yourself — or that you are a failure or have let yourself or your family down(Required) 0 | Not at all 1 | Several Days 2 | More than half of the days 3 | Nearly all of the days Trouble concentrating on things, such as reading the newspaper or watching television(Required) 0 | Not at all 1 | Several Days 2 | More than half of the days 3 | Nearly all of the days Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual(Required) 0 | Not at all 1 | Several Days 2 | More than half of the days 3 | Nearly all of the days Thoughts that you would be better off dead or of hurting yourself in some way(Required) 0 | Not at all 1 | Several Days 2 | More than half of the days 3 | Nearly all of the days If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?(Required) 0 | Not at all 1 | Several Days 2 | More than half of the days 3 | Nearly all of the days I did not check off any problems Post Custom Field Post Custom Field
