Wellbeing Check-In

This short questionnaire helps me understand how you have been feeling recently, so I can make sure I am providing the right support for you.

There are 10 questions about how you have felt over the past week. It takes about two minutes.

Your answers are confidential and will only be seen by me.

Your first name(Required)
DD slash MM slash YYYY

Over the last week

1. I have felt tense, anxious, or nervous(Required)
2. I have felt I have someone to turn to for support when needed(Required)
3. I have felt able to cope when things go wrong(Required)
4. Talking to people has felt too much for me(Required)
5. I have felt panic or terror(Required)
6. I made plans to end my life(Required)
7. I have had difficulty getting to sleep or staying asleep(Required)
8. I have felt despairing or hopeless(Required)
9. I have felt unhappy(Required)
10. Unwanted images or memories have been distressing me(Required)
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Consent(Required)