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Edinburgh Postnatal Depression Scale
After you select the name of the provider you are scheduled to see, the health form will be displayed.
Patient Information
*
Please provide your full legal name as it appears on your driver's license, state identification card, or government issued identification card.
Birth Month
January
February
March
April
May
June
July
August
September
October
November
December
Birth Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Birth Year
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
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1958
1957
1956
1955
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1953
1952
1951
1950
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1948
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1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Gender
Male
Female
Edinburgh Postnatal Depression Scale
As you have recently had a baby, we would like to know how you are feeling.
Please mark the answer which comes closest to how you have felt in the past 7 days, not just how you feel today.
Please answer every section and mark in each section only the one which applies to you.
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
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
I have blamed myself unnecessarily when things went wrong.
Yes, most of the time
Yes, some of the time
Not very often
No, never
I have been anxious or worried for no good reason.
No, not at all
Hardly ever
Yes, sometimes
Yes, very often
I have felt scared or panicky for no very good reason.
Yes, quite a lot
Yes, sometimes
No, not much
No, not at all
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
I have been so unhappy that I have had difficulty sleeping.
Yes, most of the time
Yes, sometimes
Not very often
No, not at all
I have felt sad or miserable.
Yes, most of the time
Yes, quite often
Not very often
No, not at all
I have been so unhappy that I have been crying.
Yes, most of the time
Yes, quite often
Only occasionally
No, never
The thought of harming myself has occurred to me.
Yes, quite often
Sometimes
Hardly ever
Never
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