Wellness Assessment
  • Wellness Assessment Quiz

    Wellness Assessment Quiz

  • Are you currently a patient/client at Impireum?*
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  • Format: (000) 000-0000.

  • Anxiety Assessment Rating Scale - Over the last 2 weeks, how often have you been bothered by the following problems?

  • 1.  feel mentally foggy or forgetful, even when I rest.*
  • 2.  I snap, cry, or shut down more easily than usual.*
  • 3. I feel wired but tired — like I can’t fully relax or focus.*
  • 4. I’ve lost interest in things I used to enjoy.*
  • 5. I push through exhaustion, even when I know I need rest.*
  • 6.  I experience frequent body tension, headaches, or gut issues.*
  • 7.  I feel disconnected — like I’m functioning, but not fully here.*
  • 8.  I crave quick fixes like sugar, caffeine, or alcohol to get through the day.*
  • 9.  I feel self-conscious about my body, skin, or energy when I look in the mirror..*
  • 10. I often wake up unrefreshed, even after a full night of sleep.*

  • ***Important: Follow-Up on Your Wellness Assessment Quiz*** 

    0–4:  Normal

    5–9:  Mild

    10–14: Moderate

    15+:  Severe

    If Your Anxiety Rating score is 10 or higher, we recommend you speak with a professional mental health provider.

    An Impireum representative will reach out to you or register as a new patient.

    Or please promptly contact a mental health provider for support.

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