CHANGE YOUR BRAIN, CHANGE YOUR LIFE Master Questionnaire (Amen Test)
Copyright 2008 Daniel Amen, M.D.

Please rate yourself on each of the symptoms listed below using the following scale. If possible, to give yourself the most complete picture, have another person who knows you well (such as a spouse, lover or parent) rate you as well. When finished you can use the information at the bottom to either email or fax this document back to us, or press “Click to Sign” on the electronic form.