Depression Questionnaire - HomeopathicVibes

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Our Address: 940 E El Camino Real, Sunnyvale, CA - 94087 | 39039 Paseo Padere Parkway,Suite #209,Fremont, CA 94538

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Depression Questionnaire

Why Me?

I'm providing homeopathic services for over 20 years in entire California. My clinic is located in Sunnyvale, Fremont, and San Jose. I have treated more than 1000 patients suffering from various conditions. I also provide online consultation if you're not able to visit any of my clinics. I have more than 100 five stars reviews on Google, Yelp, and other reviews websites. If you would like to know more about me, then feel free to reach me out by phone.

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Depression Questionnaire

940 E. El Camino Real
Sunnyvale, CA 94087
harminder@homeopathicvibes.com
www.homeopathicvibes.com
Office Phone (408)737-7100
Office Fax (408)737-7102

Name *

First

Last

Email *

Do you have trouble falling sleep?

Yes
No

Do you have difficulty controlling your worries or anxieties?

Yes
No

Do you feel sad most of times?

Yes
No

Did you loose your appetite and eat less than usual?

Yes
No

Do you eat more frequently and over eat more than usual?

Yes
No

Have you ever used alcohol or drugs as a solution to this depression?

Yes
No

Have you lost or gained more than ten pounds in last two years?

Yes
No

Do you believe you are problems for others sometimes?

Yes
No

Do you have trouble concentrating or making decisions?

Yes
No

Do you have suicidal thoughts sometimes?

Yes
No

Do you think you are loosing interest in people or activities you used to enjoy?

Yes
No

Do you your energy level and memory is slowing down?

Yes
No

Do you have trouble keeping your mind on one thing?

Yes
No

Do you hear any noises in your ears?

Yes
No

Are you worried about the thing has not happened or imaginary problems?

Yes
No

Do you have palpitation, sweating, shortness of breath or cramps when stressed?

Yes
No

Do you feel tired or exhausted most of the times?

Yes
No

Does your worries interfere with your daily routine?

Yes
No

Do you your behavior or mood affecting your family or social circles?

Yes
No

Do you feel you are losing interest in one pleasurable actives?

Yes
No

Are you seeing decline in your libido?

Yes
No
Not at all
No it is better than before

Are you losing interest in sex?

Yes
No
No it is better than before

Do you get angry for feel irritable easily?

Yes
No

How do you react to anger situation?

Raise voice
Become violent
Say some thing quickly but feel guilty after sometime
Stay calm and cool.

How do you rate your public relationship?

Excellent in dealing with others
Somewhat normal
Totally withdrawn
Always Miss Judge others

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About Me

I have passion for homeopathy. I am blessed to be born in family of Homeopaths. My grand father Dr. Hazara Singh Gill was great homeopath of his times. He did his M.B.H (Bachelor of Medicine in Homeopathy) from Punjab Homeopathic Medical College Lahore in 1925.

Sunnyvale Location

Phone: 408-737-7100
Fax: 408-737-7102
Address: 940 E El Camino Real, Sunnyvale, CA 94087, United States
harminder@homeopathicvibes.com

Fremont Location

Phone: 408-737-7100
Fax: 408-737-7102
Address: 39039 Paseo Padere Parkway,Suite #209,Fremont, CA 94538, USA.
harminder@homeopathicvibes.com

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