Mental Wellness Survey

Decline in your feelings of general well-being?*
(general state of health, subjective feeling)

YesNoNot Sure

Excessive sweating or hot flashes?

YesNoNot Sure

Increased need for sleep, often feeling tired?

YesNoNot Sure

Irritability? (feeling aggressive, easily upset about little things, moody)

YesNoNot Sure

Anxiety? (feeling panicky)

YesNoNot Sure

Depressive mood?
(feeling down, sad, on the verge of tears, lack of drive, mood swings, feeling nothing is of any use)

YesNoNot Sure

Feeling that you have passed your peak?

YesNoNot Sure

Decrease in libido?

YesNoNot Sure

If you answered 4 or more call
915-585-1300 for you consultation.