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Depression Screening and Annual Checkups Survey
1.
How important do you feel annual checkups are for maintaining your overall health?
Not important
Somewhat important
Moderately important
Very important
2.
How familiar are you with completing an annual depression screening?
Not at all familiar
A little familiar
Somewhat familiar
Very familiar
3.
How comfortable do you feel answering depression screening questions?
Not comfortable
Somewhat comfortable
Comfortable
Very comfortable
4.
What, if anything, would make the depression screening process more comfortable for you?
5.
Is there anything that makes it harder to complete depression screening during a visit? Select all that apply.
Not enough time during appointments
Privacy concerns
Not sure how results are used
Stigma or discomfort talking about mood
Hard to understand the questions
Prefer a different format (paper/tablet/verbally)
No barriers
Other (please specify)
Other (please specify)
6.
Do any of the following make it difficult to come to the clinic for screening or follow-up care? Select all that apply.
Transportation challenges
Cost of travel/gas
Work or school schedule
Childcare or caregiving responsibilities
Mobility or health issues
Distance to the clinic
Weather or seasonal challenges
Feeling unsafe or uncomfortable getting to the clinic
No barriers
Other (please specify)
Other (please specify)
7.
Are you between the ages of 18–44?
Yes
No
Prefer not to say
8.
Is there anything else you want us to know about your experience with depression screening?
