Questionnaires

Substance Abuse and Mental Health Questionnaires

The following questionnaires are meant to help determine if you may be possibly suffering from substance abuse or substance dependency, anxiety, or a major depressive episode. Call the Methodist Richardson Medical Center HelpLine at 469-204-6920 for more information.

If you are having suicidal thoughts, call 911 or have someone drive you to the nearest emergency room.

Substance Abuse Questionnaire
Answer each question by checking "Yes" or "No." Please review your responses. If you responded "Yes" to any one of items 1 through 4, you may very possibly have a substance abuse problem. If you responded "Yes" to any three (3) of items 5 through 11, you may possibly have a substance dependence problem.

Anxiety Questionnaire
Answer each question by checking "Yes" or "No." Please review your responses. If you checked "Yes" to five (5) or more items (and at least one of the "Yes" checked items was item 1 or item 2), you may possibly be suffering from agoraphobia.

Depression Questionnaire
Answer each question by checking "Yes" or "No." Please review your responses. If you checked "Yes" to five (5) or more items (and at least one of the "Yes" checked items was item 1 or item 2), you may possibly be suffering from a major depressive episode.