Take Mental Health Survey
The following survey is the Hopkins Symptom Checklist. This checklist survey measures symptoms of anxiety and depression. It consists of 25 items. All items need to be answered to proceed to your total. If you would like to speak with us, supply your contact information as part of the survey. Your personal information and survey results are kept confidential.
Name(Optional): Email(Optional): Phone(Optional):
Including your name and contact information will make you eligible for a complimentary consultation via phone or email. Your survey results, name, and contact information will be kept in strict confidence.
Part 1: Anxiety Symptoms Not at all A little Quite a bit Extremely
1. Suddenly scared for no reason
2. Feeling fearful
3. Faintness, dizziness, or weakness
4. Nervousness or shakiness inside
5. Heart pounding or racing
6. Trembling
7. Feeling tense or keyed up
8. Headaches
9. Spells of terror or panic
10. Feeling restless, can't sit still
Part 2: Depression Symptoms Not at all A little Quite a bit Extremely
11. Feeling low in energy, slowed down
12. Blaming yourself for things
13. Crying easily
14. Loss of sexual interest or pleasure
15. Blaming yourself for things
16. Difficulty falling asleep or staying asleep
17. Feeling hopeless about the future
18. Feeling sad
19. Feeling lonely
20. Thoughts of ending your life
21. Feeling of being trapped or caught
22. Worrying too much about things
23. Feeling no interest in things
24. Feeling everything is an effort
25. Feeling worthless

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