Low Mood Indicator

Please complete the form below about your mood.

Choose the answer for each of the questions as you have been in the previous week. Each has a score 0 - 3

Your Total Score indicates:

0 - 7 = not significant

8 - 10 = possible or borderline low mood

11 - 21 = significant low mood

Date:*

Your name:*

Your email:*

I give my full consent to be contacted by email by Debbie Featherstone*

I agree

Please answer ALL seven questions. Your answers need to reflect how you have been during the previous week

1. I still enjoy the things I used to enjoy*

2. I can laugh and see the funny side of things*

3. I feel cheerful*

4. I feel as if I am slowed down*

5. I have lost interest in my appearance*

6. I look forward with enjoyment to things*

7. I can enjoy a good book, or radio or TV programme*

Thank you for completing your answers. Is there anything you would like to add?

Now press SEND - you will receive a copy of your answers by email