Personal Feelings Questionnaire Form
Please take a moment to reflect and share how you have been feeling recently. Your responses are confidential and help you check in with your feelings.
How would you describe your feelings recently?
*
Which emotions have been most present for you?
*
Happy
Calm
Content
Anxious
Sad
Frustrated
Angry
Overwhelmed
Other
Are there any situations or triggers that have affected your feelings recently?
How intense have your feelings been overall?
*
Not intense
1
2
3
4
5
6
7
8
9
Extremely intense
10
1 is Not intense, 10 is Extremely intense
How often have you experienced these feelings?
*
Please Select
Rarely
Sometimes
Often
Almost always
What coping strategies have you used recently?
Talking to someone
Physical activity
Creative activities
Relaxation techniques
Spending time outdoors
Other
Would you like any support or follow-up?
Yes
No
Maybe
Additional notes (optional)
Submit
Should be Empty: