Mental Health Assessment

Felt down, depressed, or hopeless?

Felt anxious or worried?

Overall mood lately?

Trouble falling or staying asleep?

Yes

No

Feel rested after sleep?

Yes

No

Often feel stressed or overwhelmed?

Yes

No

Difficulty focusing?

Yes

No

Feel lonely?

Low energy lately?

Yes

No

Noticeable change in appetite or weight?

Yes

No

Lost interest in usual activities?

Yes

No

Feel able to handle stress?

Yes

No

How would you rate your mental well-being overall?

Poor

Fair

Good

Very Good

Excellent