Phone Your Details for K10 Form First Name * Last Name * Date * For all questions, please select the appropriate response for the last 4 weeks. 1. About how often did you feel tired out for no good reason? * Please select the appropriate response from the drop down menu. 1. None of the Time 2. A little of the Time 3. Some of the Time 4. Most of the Time 5. All of the Time 2. About how often did you feel nervous? * Please select the appropriate response from the drop down menu. 1. None of the Time 2. A little of the Time 3. Some of the Time 4. Most of the Time 5. All of the Time 3. About how often did you feel so nervous that nothing could calm you down? * Please select the appropriate response from the drop down menu. 1. None of the Time 2. A little of the Time 3. Some of the Time 4. Most of the Time 5. All of the Time 4. About how often did you feel hopeless? * Please select the appropriate response from the drop down menu. 1. None of the Time 2. A little of the Time 3. Some of the Time 4. Most of the Time 5. All of the Time 5. About how often did you feel restless or fidgety? * Please select the appropriate response from the drop down menu. 1. None of the Time 2. A little of the Time 3. Some of the Time 3. Most of the Time 5. All of the Time 6. About how often did you feel so restless you could not sit still? * Please select the appropriate response from the drop down menu. 1. None of the Time 2. A little of the Time 3. Some of the Time 4. Most of the Time 5. All of the Time 7. About how often did you feel depressed? * Please select the appropriate response from the drop down menu. 1. None of the Time 2. A little of the Time 3. Some of the Time 4. Most of the Time 5. All of the Time 8. About how often did you feel that everything was an effort? * Please select the appropriate response from the drop down menu. 1. None of the Time 2. A little of the Time 3. Some of the Time 4. Most of the Time 5. All of the Time 9. About how often did you feel so sad that nothing could cheer you up? * Please select the appropriate response from the drop down menu. 1. None of the Time 2. A little of the Time 3. Some of the Time 4. Most of the Time 5. All of the Time 10. About how often did you feel worthless? * Please select the appropriate response from the drop down menu. 1. None of the Time 2. A little of the Time 3. Some of the Time 4. Most of the Time 5. All of the Time Calculation of answers Total: Comments / Questions