Youth Emotional Assessment Form
Please answer the following questions to help assess your current emotional well-being. This assessment is designed to be approachable and supportive.
How would you rate your overall mood over the past week?
*
1
2
3
4
5
In the past week, how often have you felt stressed or overwhelmed?
*
Never
Rarely
Sometimes
Often
Almost always
How connected do you feel to friends or supportive people right now?
*
Not at all connected
1
2
3
4
Very connected
5
1 is Not at all connected, 5 is Very connected
How easy is it for you to talk about your feelings with someone you trust?
*
Very easy
Somewhat easy
Neutral
Somewhat difficult
Very difficult
How often do you feel hopeful about the future?
*
Always
Often
Sometimes
Rarely
Never
How well do you feel you cope with challenges or setbacks?
*
Not well at all
1
2
3
4
Very well
5
1 is Not well at all, 5 is Very well
How much energy or motivation have you had for daily activities recently?
*
None
1
2
3
4
A lot
5
1 is None, 5 is A lot
Have you experienced any major changes or challenges recently?
*
Yes
No
Prefer not to say
What is one thing that helps you feel better when you're down?
Is there anything else you would like to share about your emotional well-being?
Submit Assessment
Should be Empty: