I am stressed about school, sports, or life activities.
Yes, all the time
Yes, but only occasionally
No, I have no problems managing my work
No, I'm chilling.
Do you prefer to be alone or surrounded by people?
I prefer having alone time
I love to be social
I feel like I would rather spend time alone nowadays.
Yes, this is normal for me
Yes, but I normally am social
No, I like being around people
No, I want to go out!
I feel hopeless.
rarely all the time
In the past months, my weight has changed
not at allsignificantly
Lately, I have been feeling more down.
All the time and I don't know why
Yes, but I have my reasons
Occasionally, but only because I'm stressed
No, I feel fine
I am more tired lately.
Yes, all the time
Yes, but only because of my workload
Sometimes, school is tiring
No, I get enough sleep
I get enough sleep.
Yes, and I love it
No, I have difficulty staying asleep
No, I like to stay up late
No, I cannot fall asleep
I worry about specific things for a long time.
Yes, and this is the way I've always been.
Yes, and it affects my wellbeing.
No, I'm not one to hold onto things.
I am tired for no reason.
Yes
No
I have been lower for:
0-1 week
2-3 weeks
More than 3 weeks
Do you have any stomach pain?
Yes
No
Have you had any abnormal muscle aches?
Yes
No
Do you feel like anything has significantly impacted your life?
Yes
No
How have you been lately?
absolute worstabsolute best
Do you have a family history of any mental health problems?
Yes
No
Does your sadness/stress make sense to you?
Yes, I have reasons for my feelings
No, I don't know why I feel this way
I am not sad or stressed
Are you doing anything to take care of yourself?
Yes
No
Can you link your sadness to any events in your life?
Yes
No, I'm just sad
I do not experience prolonged sadness
Have you had significant changes in your grade performance?
Yes, and I am usually on top of my schoolwork
Yes, I'm not the best at school
No, I am keeping up with my work
Do you experience any thoughts of wanting to hurt yourself?
Yes
No
If you experience thoughts of self harm, have you thought of a specific way to harm yourself?
Yes, I know what I would do
No, I just think about it
I do not experience thoughts of self harm
Have you ever tried to physically hurt yourself?
Yes, I do it often
Yes, but I do not do it anymore
No, I've only thought about it
No, I have not ever tried to hurt myself
My self esteem has been getting lower.
Yes
No
I often criticize myself
Yes, I tend to do this
Yes, and this is a new thing for me
No, not really
On a scale from 1-10, how self-conscious/insecure would you say you've been these past few months
not at all a lot
Do you frequently panic?
Yes, I tend to panic a lot
Yes, recently I've been more fearful
No, I do not frequently panic
I have been on edge lately.
Yes
No
Have you had a panic attack in the past 6 months?
Yes
No
If you have had a panic attack in the past 6 months, did you have difficulty breathing or experience chest pains?
Yes
No
Not Applicable
Do you feel like you are okay right now?
Yes, I am living my life in peace
No, I am extremely stressed/sad
No, I am just stressed about life
I could be better
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