Mood Disorder Questionnaire

Has there ever been a period of time when you were not your usual self and...


Yes
No

Yes
No

Yes
No

Yes
No

Yes
No

Yes
No

Yes
No

Yes
No

Yes
No

Yes
No

Yes
No

Yes
No

Yes
No


Yes
No

No Problem
Minor Problem
Moderate Problem
Serious Problem




East Valley Psychiatric Services