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Which Element Do You Represent?

On a scale from 1-10, how do you rate your mental health?
1
2
3
4
5
6
7
8
9
10
How do you cope with your mental health struggles?
How do you remain interconnected by others the most?
Friends
Family
Friends and Family
My therapist/counselor
I don't remain interconnected
Do you believe you deal with your mental health by staying calm, cool, and collected, or do you tend to lash out?
Calm and collected
I become somewhat hostile
How well is your physical well-being taken care of on average?
Excellent
Somewhat good
Average
Somewhat poor
Poor
Not sure
What are some mental health activities you turn to?
Exercise
Meditation
Journaling
Cooking/baking healthy recipes
Reading
Music
Dance
I don't practice any mental health activities
Other
Please Specify:
Do you struggle with any mental illnesses or disorders? If so, which ones?
Depression
Insomnia
Anxiety
Bipolar Affective Disorder
Dementia
OCD
PTSD
Autism
I do not have any mental illnesses or disorders.
Other
Please Specify:
Is there a particular source that unbalances your mental health the most?
Yes
No
How many hours do you sleep per day?
1-3 hours
4-5 hours
6-7 hours
8-9 hours
10-12 hours
Describe your mood on a daily basis
Happy
Calm
Sad
Indifferent
Do you tend to bottle up your feelings to yourself?
Very accurate
Moderately accurate
Neither accurate nor inaccurate
Moderately inaccurate
Very inaccurate
When a mild situation hits you that unbalances your mental health, how fast do you bounce back?
Almost immediately
A few hours
A few days
A week or more
Overall, how do you feel mentally today?
1
2
3
4
5
6
7
8
9
10
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