Couples–Amen Clinic Questionnaire

Q 1-12 Score: _______________

Q 13-24 Score: _______________

Q 1-24 Score: _______________

Q 25-36 Score: _______________

Q 37-46 Score: _______________

Q 47-58 Score: _______________

Q 59-70 Score: _______________

AMEN CLINIC Mood Disorder Questionnaire

For the following questions, check the answer that best applies to you. Answer each question as best you can.

Has there ever been a period of time when you were not your usual self and...