1.	Difficulty sleeping	________
2.	Sleep too much	________
3.	Weight gain or loss (at least 10 lbs. in the last 2 weeks)	________
4.	Agitation or Irritability	________
5.	Difficulty concentrating	________
6.	Low interest in fun activities	________
7.	Lack of sex drive	________
8.	Feelings of hopelessness	________
9.	Thoughts of death	________
10.	Plan for suicide	________
11.	Substance abuse	________
12.	Separated, Divorced	________
13.	No Intimate Relationships	________
14.	Recent loss causing grief	________

		If you scored 6 items or more with 3 or above you are significantly depressed and could benefit from counseling.  You have taken the first step!
			Please feel free to call or e-mail me for an appointment or with any questions Carole Bergen, Ph.D. Call (253) 853-5800 for an appointment - Gig Harbor, Washington Fax: (253) 858-5430 E-mail:  carole@therapy4life.com Member of   A.A.M.F.T       License # M.F.T. 32512 Individual Therapy  | Relationship  Inventory Copyright © 2000 Therapy4life.com. All Rights Reserved