1 Almost Never – 2 Sometimes – 3 Often – 4 A lot – Unknown or Not Documented If yes, where? __________ I have low energy : 0 Not at all – 1 Almost Never – 2 Sometimes – 3 – 4 A lot – Unknown or Not Documented ABOUT MY FEELINGS (problems with…) I feel afraid or scared: 0 Not at all – 1 Almost Never – 2 Sometimes – 3 Often – 4 A lot – Unknown or Not Documented I feel sad or blue: 0 Not at all – 1 Almost – 2 Sometimes – 3 Often – 4 A lot – Unknown or Not Documented I feel angry: 0 Not at all – 1 Almost Never – 2 Sometimes – 3 Often – 4 A lot – Unknown or Not Documented I have trouble sleeping: 0 Not at all – 1 Almost Never – 2 Sometimes – 3 – 4 A lot – Unknown or Not Documented I worry about what will happen to me: 0 Not at all – 1 Almost Never – 2 Sometimes – 3 Often – 4 A lot – Unknown or Not Documented
1 – Almost Never 2 – Sometimes 3 – Often 4 – A lot Unknown or Not Documented If yes, where? __________ I have low energy : 0 – Not at all 1 – Almost Never 2 – Sometimes 3 – 4 – A lot Unknown or Not Documented ABOUT MY FEELINGS (problems with…) I feel afraid or scared: 0 – Not at all 1 – Almost Never 2 – Sometimes 3 – Often 4 – A lot Unknown or Not Documented I feel sad or blue: 0 – Not at all 1 – Almost 2 – Sometimes 3 – Often 4 – A lot Unknown or Not Documented I feel angry: 0 – Not at all 1 – Almost Never 2 – Sometimes 3 – Often 4 – A lot Unknown or Not Documented I have trouble sleeping: 0 – Not at all 1 – Almost Never 2 – Sometimes 3 – 4 – A lot Unknown or Not Documented I worry about what will happen to me: 0 – Not at all 1 – Almost Never 2 – Sometimes 3 – Often 4 – A lot Unknown or Not Documented
Pedimacs_Users_Guide_v5_0_2018_03_26.docx