Veterans and Care Farming Name First Last Email Address Phone Number Please put a checkmark next to all of the items that you believe apply to you today. Feelings of sadness, tearfulness, emptiness or hopelessness. Angry outbursts, irritability, aggressive behavior or frustration, even in small matters Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports Lack of interest in activities you once enjoyed Sleep disturbances, including insomnia or sleeping too much Upsetting dreams and nightmares about a traumatic event Tiredness and lack of energy, so even small tasks take extra effort Reduced appetite and weight loss or increased cravings for food and weight gain Anxiety, agitation or restlessness Slowed thinking, speaking or body movements Memory problems, including not remembering important aspects of a traumatic event Feelings of worthlessness or guilt, fixating on past failures or self-blame Overwhelming guilt or shame Trouble thinking, concentrating, making decision and remembering things Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide Unexplained physical problems such as back pain or headaches Recurrent, unwanted distressing memories of a traumatic event Reliving a traumatic event as if it were happening right now Severe emotional distress or physical reactions to something that reminds you of a traumatic event Trying to avoid thinking or talking about a traumatic event Avoiding places, activities or people that remind you of a traumatic event Negative thoughts about yourself, other people or the world Difficulty maintaining close relationships Feeling detached from family and friends Difficulty experiencing positive emotions Feeling emotionally numb Being easily startled or frightened Always being on guard for danger Self-destructive behavior, such as drinking too much or driving too fast