1. Do you get sleep immediately?
2. Do you feel tired the whole day?
3. Do you experience exhaustion/fatigue easily?
4. Do you tend to postpone things that you have to do?
5. Do you feel guilty?
please continue _ _ _

6. Do you feel you are a failure?
7. Do you feel fresh on getting up in the morning?
8. Do you feel like you have not had enough rest and need to sleep more, but because it is compulsory you force yourself to get up for work?
9. Comparatively, do you feel fresh in morning or evening?
10. Do you feel afraid?
11. Do you sense heart beat increasing?
12. How many times in a day or week you feel fear like feeling?
13. Do you feel sad?
14. Do you feel it is better to die?
15. Do you feel like crying?
16. Do you feel like being alone and not mixing with people?
17. Do you tend to avoid social meeting and much talking?
18. Do you feel more irritated?
19. Do you tend to forget small things?
20. Does it appear difficult to take decisions?
21. Do you feel hopeless?
22. Do you feel helpless?
23. Do you have body pains and aches in different parts of body?
24. Have you done any blood or other investigations and if so are all of them normal?
25. Do you get only temporary relief when you take treatment for body health troubles?

Dr. Ashok Koparday
Medical Director
Samadhan India
Center for Therapy, Education, Research in
Sex, Marriage, Relationships

Ex. Teaching Faculty
Seth G. S. Medical College and K. E. M. Hospital and
Grant Medical College and Sir J. J. Group of Hospitals
University of Mumbai, India


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