Health & Well-being K10 Assessment - Tribal Warrior Aboriginal Corporation

Date Completed:

Name:

Date of Birth:

Gender:

In the past month, about how often did you feel tired out for no good reason?

In the past month, about how often did you feel nervous?

In the past month, about how often did you feel so nervous that nothing could calm you down?

In the past month, about how often did you feel hopeless?

In the past month, about how often did you feel restless or fidgety?

In the past month, about how often did you feel so restless you could not sit still?

In the past month, about how often did you feel depressed?

In the past month, about how often did you feel that everything was an effort?

In the past month, about how often did you feel that nothing could cheer you up?

In the past month, about how often did you feel worthless?

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