SSCH Wellbeing Questionnaire

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Disclaimer: The information provided is for general informational purposes only and is not a substitute for professional medical advice. Always consult with a qualified healthcare provider before starting any new health, fitness, or nutrition program. Use of this information is at your own risk. We are not responsible for any adverse effects resulting from its use. By using this service you acknowledge that you have read and agree to this disclaimer. For more details, consult a healthcare professional. *

Name *

First

Last

Gender *

Email *

Occupation

Your age

I have been feeling optimistic about the future

I have been feeling useful

I have been feeling relaxed

I have been feeling interested in other people

I have had energy to spare

I've been dealing with problems well.

I have been thinking clearly

I have been feeling good about myself

I've been feeling close to other people

I've been feeling confident

I have been able to make up my own mind about things

I've been interested in new things

I've been feeling cheerful

I've been feeling loved

How much physical pain or discomfort are you experiencing currently?

Selected Value: 0

0: None 5: Severe

How fatigued or low in energy do you feel today?

Selected Value: 0

0: Full of energy 5: Completely exhausted

How would you rate your overall mental health and emotional state right now?

Are you happy with your current diet?

Is there anything specific you would like to discuss in this session.