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Mental Health Questionaire

b

  • Date Format: MM slash DD slash YYYY
  • How often, over the past 2 weeksc have you been bothered by the following:

  • not at allseveral daysmore than half the daysnearly every day
  • not at allseveral daysmore than half the daysnearly every day
  • not at allseveral daysmore than half the daysnearly every day
  • not at allseveral daysmore than half the daysnearly every day