Comprehensive Mental Health Survey

Thank you for taking the time to participate in our comprehensive mental health survey. Your responses will help us gain a deeper understanding of your mental well-being and its connection to your daily life. Your answers will remain confidential.

Hello, World!

Name

First Name

Last Name

Phone

(###)

###

####

Age

Gender

Current City, State

Describe your typical daily routine, including work/school, family life, and hobbies or activities you enjoy.

I feel generally content and at peace

I experience symptoms of anxiety in my daily life.

I experience symptoms of depression in my daily life.

I have a supportive social circle.

I feel comfortable discussing my emotions with others.

I am aware of available mental health resources.

I engage in activities that help me relax and unwind.

I feel overwhelmed by stress frequently.

I have difficulty concentrating on tasks.

I have sought professional help for my mental health.

Rate the quality of your relationships with family

Rate the quality of your relationships with friends.

Rate the quality of your relationships with colleagues/peers

How do you usually cope with stress or difficult emotions?

How often do you engage in physical exercise?

How many hours of sleep do you get on average per night?

Do you practice mindfulness or meditation?

Have you ever consulted a mental health professional?

If yes, please briefly describe your experience:

Is there anything else you would like to share about your mental health, daily life, or experiences that you believe is important for us to know?