Standardized Screening — Boojee Companion Care

UCLA Loneliness Scale (3-Item)

Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A short scale for measuring loneliness in large surveys. Research on Aging. 2004;26(6):655–672. Public domain.

Instructions: For each question below, please select the response that best describes how you have been feeling. There are no right or wrong answers.

Question 1 of 3 How often do you feel that you lack companionship?

Hardly ever Some of the time Often

Please select an answer to continue.

Question 2 of 3 How often do you feel left out?

Hardly ever Some of the time Often

Please select an answer to continue.

Question 3 of 3 How often do you feel isolated from others?

Hardly ever Some of the time Often

Please select an answer to continue.

PHQ-2 — Patient Health Questionnaire (2-Item)

Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care. 2003;41(11):1284–1292. Developed by Drs. Spitzer, Williams, Kroenke. No permission required to reproduce.

Instructions: Over the last 2 weeks, how often have you been bothered by any of the following problems? Please select one answer per question.

Question 1 of 2 Over the last 2 weeks, how often have you been bothered by little interest or pleasure in doing things?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Question 2 of 2 Over the last 2 weeks, how often have you been bothered by feeling down, depressed, or hopeless?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Your PHQ-2 responses indicate it would be helpful to complete the full PHQ-9 questionnaire below. This additional questionnaire will give a more complete picture.

PHQ-9 — Patient Health Questionnaire (9-Item)

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a Brief Depression Severity Measure. J Gen Intern Med. 2001;16(9):606–613. Developed by Drs. Spitzer, Williams, Kroenke. No permission required to reproduce.

PHQ-2 score indicates full PHQ-9 is recommended. Your PHQ-2 pre-screen score was 3 or above, which means completing all nine questions below will give the most complete picture. Please answer each question below.

Instructions: Over the last 2 weeks, how often have you been bothered by any of the following problems? Please select one answer for each question.

Question 1 of 9 Little interest or pleasure in doing things?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Question 2 of 9 Feeling down, depressed, or hopeless?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Question 3 of 9 Trouble falling or staying asleep, or sleeping too much?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Question 4 of 9 Feeling tired or having little energy?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Question 5 of 9 Poor appetite or overeating?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Question 6 of 9 Feeling bad about yourself — or that you are a failure or have let yourself or your family down?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Question 7 of 9 Trouble concentrating on things, such as reading the newspaper or watching television?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Question 8 of 9 Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Question 9 of 9 Thoughts that you would be better off dead or of hurting yourself in some way?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

GAD-7 — Generalized Anxiety Disorder (7-Item)

Spitzer RL, Kroenke K, Williams JB, Löwe B. A Brief Measure for Assessing Generalized Anxiety Disorder. Arch Intern Med. 2006;166(10):1092–1097. Developed by Drs. Spitzer, Williams, Kroenke. No permission required to reproduce.

Instructions: Over the last 2 weeks, how often have you been bothered by the following problems? Please select one answer per question.

Question 1 of 7 Feeling nervous, anxious, or on edge?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Question 2 of 7 Not being able to stop or control worrying?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Question 3 of 7 Worrying too much about different things?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Question 4 of 7 Trouble relaxing?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Question 5 of 7 Being so restless that it is hard to sit still?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Question 6 of 7 Becoming easily annoyed or irritable?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Question 7 of 7 Feeling afraid, as if something awful might happen?

Not at all Several days More than half the days Nearly every day

Please select an answer to continue.

Wellness Screening

Your Screening Results

Before we begin

Your Screening Results