Postnatal Maternal Screening Scale

As you have recently had a baby, we would like to know how you are feeling. Please check the answer that comes closest to how you have felt IN THE PAST 7 DAYS, not just how you feel today. This questionnaire is intended to be completed by mom. If mom is physically unable to complete this form, please note who is completing the questionnaire in the name field below.


Mothers Name
Email Address
Infant's Name
Infant's Date of Birth  
Physician's Name
1. I have been able to laugh and see the funny side of things 

2. I have looked forward with enjoyment to things 

3. I have blamed myself unnecessarily when things went wrong 


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