Please take a few minutes to fill out this survey on your overall state of mental health. We value your feedback and your responses. Thank you for your input.
I would like to begin the survey by asking you some questions about your general health.
- Question of
Have you had any problems with your work or daily life due to any emotional problems, such as feeling depressed, sad or anxious?
- Yes
- No
- Don’t Know
- Question of
How often has your mental health affected your relationships?
- Very Often
- Somewhat Often
- Not So Often
- Not At All
- Question of
Have you ever been diagnosed with a mental disorder before?
- Yes
- No
- Question of
Can you able to adapt when changes occur?
- Not True At All
- Rarely True
- Sometimes True
- True Nearly All The Time
- Don’t Know
- Question of
How many hours do you sleep per day?
- Less Than 4
- 4-6
- 7-9
- 9+
- Question of
How often do you feel positive about your life?
- Never
- Once In A Life
- About Half The Time
- Most Of The Time
- Always
- Question of
Overall how would you rate your mental health?
- Excellent
- Somewhat Good
- Average
- Somewhat Poor
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