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Psychological Health Survey
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
How often do you experience feelings of anxiety?
Select the option that best corresponds to your experience.
Never
Rarely
Sometimes
Frequently
Always
2
Rate your overall level of happiness on a scale of 1 to 10.
1 being extremely unhappy and 10 being extremely happy.
3
In what ways do you cope with stress?
Please provide a brief description of your coping mechanisms.
4
How often do you feel overwhelmed?
Select the option that best describes your feelings of being overwhelmed.
Never
Rarely
Sometimes
Frequently
Always
5
On a scale from 1 to 5, how would you rate your current stress level?
1 being low stress and 5 being high stress.
6
Do you have trouble sleeping at night?
Please select yes or no.
Yes
No
7
How do you usually feel in social situations?
Select the option that best reflects your feelings in social settings.
Confident
Anxious
Neutral
Excited
Uncomfortable
8
Do you have any specific fears or phobias?
Please provide details if applicable.
9
Are you currently receiving any form of psychological therapy or counseling?
Please select yes or no.
Yes
No
10
How would you rate your overall mental well-being recently?
Choose the option that best describes your current mental state.
Excellent
Good
Average
Poor
Very Poor
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