The following questions ask about thoughts, feelings, and behaviors, often tied to concerns about family, health,
finances, school, and work. Please respond to each item by marking one box per row.

During the PAST 7 DAYS, I have…

Never
Occasionally
Half of the time
Most of the time
All of the time

Never
Occasionally
Half of the time
Most of the time
All of the time

Never
Occasionally
Half of the time
Most of the time
All of the time

Never
Occasionally
Half of the time
Most of the time
All of the time

Never
Occasionally
Half of the time
Most of the time
All of the time

Never
Occasionally
Half of the time
Most of the time
All of the time

Never
Occasionally
Half of the time
Most of the time
All of the time

Never
Occasionally
Half of the time
Most of the time
All of the time

Never
Occasionally
Half of the time
Most of the time
All of the time

Never
Occasionally
Half of the time
Most of the time
All of the time