Please read each statement and circle a number 0, 1, 2, 3  which indicates how much the statement applied to you over the past week or a typical week.  There are no right or wrong answers.  Do not spend too much time on any statement.

The rating scale is as follows:

0     Does not apply to me at all  –  NEVER

1     Applies to me to some degree, or some of the time  –  SOMETIMES

2     Applies to me a considerable degree, or a good part of time   –  OFTEN

3     Applies to me very much, or most of the time   –  ALMOST ALWAYS