1. On a scale of 1 to 10, 10 being the highest, where do you think your anxiety stands?
2. How long has it been since you first experienced anxiety after birth?
A. Four weeks or more
B. A few days
C. Two weeks or more
3. How do you feel after you sleep?
A. I feel rested but not refreshed
B. I feel energized
C. I feel fine but fatigued
4. Are you able to eat properly?
A. No, I constantly feel nauseous
B. Yes, as long as my partner is around
C. Yes, but I am not eating healthy food
5. Are you getting regular headaches, gastric issues, or any other health issues post-pregnancy?
A. Yes, often
B. No, I don’t
C. Yes, but not often
6. Do you feel worried for your baby even after they are well-fed and tucked in bed?
A. Yes, and it tires me
C. Yes, but not excessively
7. Do you think your mood changes are inhibiting you from leading your daily routine?
A. Yes, but I am coping with it
B. Not as much
C. Yes, and it is difficult
8. Are you finding it difficult to cope with your new lifestyle?
A. Yes, I do miss my old life
B. Yes, but I am ready for it
C. Yes, I am unable to cope
9. Do you think you have enough support to look after the baby?
A. No, I don’t
B. Yes, even then, it’s hard
C. I do, but I end up doing most things
10. Do you feel like crying even if you don’t feel sad?
A. Not really
B. Yes, I do
C. Yes, almost everyday