Emotional Feedback Survey Form
Please share your honest emotional feedback to help us understand your experience.
Overall, how would you rate your current emotional state?
*
1
2
3
4
5
How frequently have you experienced positive emotions today?
*
Never
1
2
3
4
Very Often
5
1 is Never, 5 is Very Often
Which emotion best describes how you feel right now?
*
Happy
Calm
Sad
Anxious
Frustrated
Other
Please indicate your agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I felt supported today.
1
2
3
4
5
I was able to express my feelings.
6
7
8
9
10
I found it easy to manage my emotions.
11
12
13
14
15
How intense were your emotions during the past few hours?
*
Not intense
1
2
3
4
Very intense
5
1 is Not intense, 5 is Very intense
How satisfied are you with your ability to cope with negative emotions today?
*
1
2
3
4
5
Which of the following best describes your emotional experience today?
*
Mostly positive
Mixed emotions
Mostly negative
How comfortable did you feel discussing your emotions today?
*
Not comfortable
1
2
3
4
Very comfortable
5
1 is Not comfortable, 5 is Very comfortable
How likely are you to seek support when feeling overwhelmed?
*
1
2
3
4
5
Please share any additional comments about your emotional experience.
Submit Feedback
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