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.
On a scale of 1 to 5, how often do you feel overwhelmed by stress in your daily life?

RarelyOccasionallySometimesOftenAlmost always
How would you rate your overall mood over the past week?

Very positivePositiveNeutralNegativeVery negative
Do you often experience feelings of sadness or hopelessness?

Yes, frequentlySometimesRarelyNo, never
In the past month, how frequently have you felt anxious or worried?

Almost every daySeveral times a weekOnce a weekRarelyNever
How satisfied are you with your current level of social support?

Very satisfiedSatisfiedNeutralDissatisfiedVery dissatisfied
Do you find it easy or difficult to express your emotions to others?

Very easyEasyNeither easy nor difficultDifficultVery difficult
How often do you experience intrusive or negative thoughts?

Very oftenOftenOccasionallyRarelyNever
How would you rate your ability to cope with life's challenges and setbacks?

Very effectiveEffectiveNeutralIneffectiveVery ineffective
Do you feel a sense of purpose or meaning in your life?

Yes, stronglyYes, somewhatNeutralNo, not reallyNo, not at all
How often do you engage in activities that bring you joy or relaxation?

Multiple times dailyDailyA few times a weekRarelyNever
How well do you sleep on average?

Very wellWellFairly wellPoorlyVery poorly
How satisfied are you with your current level of physical activity?

Very satisfiedSatisfiedNeutralDissatisfiedVery dissatisfied
Do you often find yourself withdrawing from social interactions?

Yes, frequentlySometimesRarelyNo, never
In the past month, have you experienced feelings of guilt or worthlessness?

Yes, frequentlyOccasionallyRarelyNo, never
How often do you engage in self-care activities (e.g., meditation, hobbies, relaxation techniques)?

Multiple times dailyDailyA few times a weekRarelyNever
How well do you manage your time and responsibilities?

Very wellWellFairly wellPoorlyVery poorly
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Feels Test

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