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Mental Health Questionnaire

The following questionnaire is designed to help you determine if you have any symptoms of a mental health disorder and could benefit from professional help. Please be as truthful as possible in responding to the questions.

In the past month, how hard has it been for you to do the following things?

  1. Get to places on time
  2. Make everyday decisions
  3. Handle money, pay bills
  4. Do household chores like cleaning, cooking, laundry
  5. Complete tasks at work or school
  6. Enjoy leisure time activities
  7. Adjust to life stresses such as separation, divorce, moving, death
  8. Maintain relationships with family and close friends
  9. Get along with other people
  10. Feel self-confident and independent
  11. Feel satisfaction with your life