Mental Well-Being Self-Assessment Questionnaire Form
Reflect on your current mental well-being by answering each question honestly. This self-assessment is designed to help you gain insight into various aspects of your mental state.
Overall, how would you rate your current mood?
*
1
2
3
4
5
How often have you felt stressed or overwhelmed in the past week?
*
Never
Rarely
Sometimes
Often
Almost always
How satisfied are you with the quality of your sleep recently?
*
Very dissatisfied
1
2
3
4
Very satisfied
5
1 is Very dissatisfied, 5 is Very satisfied
In the past week, how much energy have you had for daily activities?
*
None
A little
Some
Most
All
How often do you feel connected and supported by people around you?
*
Never
Rarely
Sometimes
Often
Always
How well do you feel you are coping with challenges right now?
*
Not coping at all
1
2
3
4
Coping very well
5
1 is Not coping at all, 5 is Coping very well
How motivated do you feel to pursue your goals or interests?
*
Not at all
Slightly
Moderately
Very
Extremely
How frequently have you experienced feelings of anxiety or worry recently?
*
Never
Rarely
Sometimes
Often
Almost always
How easily can you focus on tasks or activities?
*
Very difficult
1
2
3
4
Very easy
5
1 is Very difficult, 5 is Very easy
Please indicate how strongly you agree or disagree with the following statements about your social engagement.
*
Rows
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I enjoy spending time with others
1
2
3
4
5
I feel comfortable in social situations
6
7
8
9
10
I have people I can turn to for support
11
12
13
14
15
Submit Assessment
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