Screening form Please enable JavaScript in your browser to complete this form.Booking Code: *Over the last 2 weeks, how often have you been bothered by having little interest or pleasure in doing things? *Not at allSeveral daysMore than half the daysNearly every dayOver the last 2 weeks, how often have you been bothered by feeling down, depressed or hopeless? *Not at allSeveral daysMore than half the daysNearly every dayOver the last 2 weeks, how often have you been bothered by feeling nervous, anxious or on edge *Not at allSeveral daysMore than half the daysNearly every dayOver the last 2 weeks, how often have you been bothered by not being able to stop or control worrying? *Not at allSeveral daysMore than half the daysNearly every dayIn the past month how much have you felt very upset when something reminded you of a stressful experience from the past? *Not at allA little bitModeratelyQuite a bitExtremelyIn general, how would you describe your relationship with your partner? *A lot of tensionSome tensionNo tensionDo you and your partner work out (settle or resolve) argument with…? *Great difficultySome difficultyNo difficultyIn the past 12 months have you ever drunk or used drugs (eg: cigarette, tramadol, Marijuana, codeine, crystal meth, cocaine, rohypnol or alcohol) more than you meant to? *YesNoIn the past 12 months have you felt you wanted or needed to cut down on your drinking or drug use? *YesNoDo you see things that others can’t or don’t see? *YesNoHave you ever felt that someone was playing with your mind? *YesNoSubmit THANK YOU
