If you have thoughts of harming yourself, call your doctor immediately.
Print this form and show it to your doctor. (To print, click on the Printer image on the toolbar at the top of this screen.)
If you have a score of 12 or more, please contact your physician to see if treatment for depression would be good for you.
If you are being treated for depression, get into a depression care management program for best results.
If you score less than 12, take the questionnaire again in a week. If you have increased to a score of 12 or above, please contact your physician to see if treatment for depression would be good for you.
This checklist is intended only for the purpose of identifying symptoms of depression and is not designed to provide a diagnosis or treatment. Only a doctor or other qualified healthcare professional can make a diagnosis of depression or determine a treatment plan.