.

Survey about Feelings and Relationships

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

Secured
1

How have you been feeling lately?

Select how you have been feeling recently.
2

On a scale of 1 to 10, please rate your overall mood.

Rate your mood with 1 being extremely low and 10 being extremely high.
3

Are you currently in a relationship?

Please select your current relationship status.
4

Do you suffer from any disorders or mental health issues?

Briefly describe if you are suffering from any disorders or mental health issues.
5

How have your relationships with others been lately?

Select the option that best describes your recent relationships.
6

Have you sought professional help for your mental health?

Answer whether you have received professional help for your mental health.
7

How often do you engage in self-care activities?

Choose the frequency at which you practice self-care activities.
8

Would you like to share any specific emotions you have been experiencing?

Provide details about any specific emotions you are going through.
9

Do you believe your current mood is affecting your relationships?

Select whether your mood is impacting your relationships with others.
10

In your opinion, what contributes most to your emotional well-being?

Identify the factors that you believe positively influence your emotional well-being.