Self Feelings Check-In Survey
Take a moment to reflect on how you're feeling right now. Your responses help you gain awareness of your current emotional state.
How are you feeling overall right now?
*
Very good
Good
Neutral
Not so good
Bad
How would you rate your current energy level?
*
1
2
3
4
5
How stressed do you feel right now?
*
Not at all stressed
1
2
3
4
Extremely stressed
5
1 is Not at all stressed, 5 is Extremely stressed
How connected do you feel to others today?
*
Not at all connected
1
2
3
4
Very connected
5
1 is Not at all connected, 5 is Very connected
Which emotions are you experiencing right now? (Select all that apply)
Happy
Calm
Anxious
Sad
Frustrated
Excited
Tired
Other
In the past 24 hours, how often did you experience positive emotions?
All the time
Most of the time
Sometimes
Rarely
Not at all
How well are you coping with challenges at the moment?
Not coping well
1
2
3
4
Coping very well
5
1 is Not coping well, 5 is Coping very well
What is one thing that is contributing to how you feel today?
Is there anything you would like to do to improve your mood or well-being?
Submit
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