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Name:
Date:
Please read each statement and circle a number 0, 1, 2, or 3, which indicates how much the statement applied to you OVER
THE PAST WEEK. There are no right or wrong answers. Do not spend too much time on any statement.
Not at
all
Some
times
Frequently
Most of
the time
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0
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/var/www/apps/conversion/tmp/scratch_7/333652733.doc
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/var/www/apps/conversion/tmp/scratch_7/333652733.doc