Please answer the questions below, rating yourself on each of the criteria shown using the scale on the right side of the page. As you answer each question, select the bubble next to the answer that best describes how you have felt and conducted yourself over the past 6 months. The results of this assessment quiz will be emailed to your healthcare professional to discuss during your initial appointment.

Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute.