Survey about Feelings and Relationships

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


How have you been feeling lately?

Select how you have been feeling recently.

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.

Are you currently in a relationship?

Please select your current relationship status.

Do you suffer from any disorders or mental health issues?

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

How have your relationships with others been lately?

Select the option that best describes your recent relationships.

Have you sought professional help for your mental health?

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

How often do you engage in self-care activities?

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

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

Provide details about any specific emotions you are going through.

Do you believe your current mood is affecting your relationships?

Select whether your mood is impacting your relationships with others.

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

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