Feels Good Test

Feels Test

Mike Manor, CNHP, HTH (715) 489-5252 Mike-Manor.com
The purpose of this survey is to appropiately assess an individuals well-being and mental state.
Name*

First NameMiddle NameLast Name
Date of Birth*
Contact Number*

Country CodePhone Number
Email*
example@example.com

Read each statement in each section then check all that apply to you.

In each section (of 3 statements) you can check all, none or any number of statements that apply to you.
RarelyOccasionallySometimesOftenAlmost always
Very positivePositiveNeutralNegativeVery negative
Yes, frequentlySometimesRarelyNo, never
Almost every daySeveral times a weekOnce a weekRarelyNever
Very satisfiedSatisfiedNeutralDissatisfiedVery dissatisfied
Very easyEasyNeither easy nor difficultDifficultVery difficult
Very oftenOftenOccasionallyRarelyNever
Very effectiveEffectiveNeutralIneffectiveVery ineffective
Yes, stronglyYes, somewhatNeutralNo, not reallyNo, not at all
Multiple times dailyDailyA few times a weekRarelyNever
Very wellWellFairly wellPoorlyVery poorly
Very satisfiedSatisfiedNeutralDissatisfiedVery dissatisfied
Yes, frequentlySometimesRarelyNo, never
Yes, frequentlyOccasionallyRarelyNo, never
Multiple times dailyDailyA few times a weekRarelyNever
Very wellWellFairly wellPoorlyVery poorly
Thank you for submitting your form

Once you press “Submit” you’re done! I’ll be in touch with you soon.
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Feels Test