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Postpartum Depression Assessment

Postpartum Depression Assessment

First Name*
Last Name*
Address
Your Date of Birth
Baby's Date of Birth
Phone*
Email*
As you are pregnant or have recently had a baby, we would like to know how you are feeling. Please check the answer that comes closest to how you have felt IN THE PAST 7 DAYS, not just how you feel today.
In the past 7 days
1. I have been able to laugh and see the funny side of things
- As much as I always could
- Not quite so much now
- Definitely not so much now
- Not at all
2. I have looked forward with enjoyment to things
- As much as I ever did
- Rather less than I used to
- Definitely less than I used to
- Hardly at all
3. I have blamed myself unnecessarily when things went wrong
- Yes, most of the time
- Yes, some of the time
- Not very often
- No, never
4. I have been anxious or worried for no good reason
- No, not at all
- Hardly ever
- Yes, sometimes
- Yes, very often
5. I have felt scared or panicky for no very good reason
- Yes, quite a lot
- Yes, sometimes
- No, not much
- No, not at all
6. Things have been getting on top of me
- Yes, most of the time I haven't been able to cope at all
- Yes, sometimes I haven't been coping as well as usual
- No, most of the time I have coped quite well
- No, I have been coping as well as ever
7. I have been so unhappy that I have had difficulty sleeping
- Yes, most of the time
- Yes, sometimes
- No, not very often
- No, not at all
8. I have felt sad or miserable
- Yes, most of the time
- Yes, quite often
- Not very often
- No, not at all
9. I have been so unhappy that I have been crying
- Yes, most of the time
- Yes, quite often
- Only occasionally
- No, never
10. The thought of harming myself has occured to me
- Yes, quite often
- Sometimes
- Hardly ever
- Never

Obstetric Services

About Women Ob-Gyn is committed to providing you with high-quality care at each stage of your pregnancy, including:

Routine Prenatal Care
Labor and Delivery
Ultrasound

Signs Of Labor
Genetic Testing
Safe Medications During Pregnancy

Foods To Avoid During Pregnancy
Maternity Hospital Tours
Postpartum Depression Assessment

Office Locations

WOODBRIDGE

Potomac Center
2296 Opitz Blvd.,
Suite 440
Woodbridge, VA 22191

LORTON

Lorton Station Town Center
8998-A Lorton Station Blvd.
Lorton, VA 22079

STAFFORD

Doc Stone Commons
95 Dunn Drive,
Suite 205
Stafford, VA 22556

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