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If you suffer from depression, have you seen a physician to talk about depression ?
 
yes
 
no
 
 
 
Is the father/mother of your child an active participant in their lives?
 
yes
 
no
 
 
 
Have you used drugs to cope with any issues?
 
yes
 
no
 
 
 
Are you or have you participated in any support group or counseling?
 
yes
 
no
 
 
 
If so, do you utilize any of the community resouces available to you?
 
yes
 
no
 
 
 
Are there community resources available to you?
 
yes
 
no
 
 
 
Do you have the support of your family ?
 
yes
 
no
 
 
 
Are you or have you ever suffered from depression?
 
yes
 
no
 
 
 
Are you a male single parent?
 
yes no
 
 
 
Are you a female single parent?
 
yes
 
no
 
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