Health & Well-being Assessment | Tribal Warrior Aboriginal Corporation

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Date Completed:

Name:

Date of Birth:

Gender:

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

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 that everything was an effort?

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

Any other comments

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