How often do you experience mood swings? Once a month One in 15 days Weekly once Daily None Do you feel more anxious or stressed than usual? No, not at all Briefly in a day or 3 times a week 1 to 2 hours daily More than 4 hours a day None How would you rate your sleep quality over the past month? 7-8 hours of uninterrupted sleep 6-7 hours of uninterrupted sleep 5-6 hours of uninterrupted sleep Less than 5 hours sleep None Have you noticed any changes in your concentration or memory? Slight changes (1-25%) Moderate changes (26-50%) Significant changes (51-75%) Severe changes (76-100%) None How often do you feel overwhelmed by your responsibilities? Rarely Sometimes Often Almost always None Do you find yourself withdrawing from social activities or hobbies you once enjoyed? Never Once a month 2-3 times a month Nearly all the time None How would you describe your overall energy levels recently? Feeling very energetic, able to perform all activities and more without fatigue Feeling okay, able to perform daily activities but with noticeable fatigue Tired most of the time, able to perform some activities but with effort Struggling to stay awake, minimal physical activity possible None Have you experienced any sudden or intense feelings of sadness or depression? Not at all Several days Frequently Nearly every day None How often do you feel irritable or easily frustrated? 1-2 days in the past week 3-4 days in the past week 5-6 days in the past week Every day in the past week None Have you noticed any changes in your interest in sexual activity? No changes Slight changes Moderate changes Significant changes None 1 out of 2 Name Email Phone Time's up
