This mood assessment survey form is something I picked up at my local pharmacy. It may be a help to pre-op patients who are on their way to the Psychiatrist office for the Psychiatric Evaluation. This could help you understand what the doctor is looking for in the interview or to help you better discuss how you feel with the doctor.

Keeping track of how you're feeling is a good way to help your doctor determine how well your medication is working. Fill out this mood assessment survey just before your next visit to your doctor, and take it with you to your appointment. If you have questions or concerns about your medication, talk to your doctor. It usually takes 4 to 6 weeks to experience the full effect of medication, and for some people it may take longer. Read each sentence carefully, and place the appropriate number to rank how often you have felt that way in the past several days.

Ranking:

A Little of the Time = 1
Some of the Time = 2
Good Part of the Time = 3
Most of the Time = 4

Questions:

I feel down-hearted and blue =

It is hard to get going in the morning =

I have crying spells or feel like it =

I have trouble sleeping at night =

* I let my mood control my eating =
(* If you are on a diet, answer as if you were not.)

I have lost interest in sex =

I have trouble with constipation =

My heart beats faster than usual =

I get tired for no reason =

I have trouble keeping my mind clear =

I find it hard to do the things I used to =

I am restless and can’t keep still =

I am not hopeful about the future =

I am more irritable than usual =

I find it difficult to make decisions =

I feel that I am useless and unwanted =

My life is empty and without meaning =

I feel that others would be better off if I were dead =

I do not enjoy the things I used to do =

I hope you can find some help with this form. I suggest you print it out and fill in the answers, then you can give it to the doctor .