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Form
6-Week Post-Bariatric Emotional Stability Check

This short check-in helps us understand how you’re feeling emotionally during your recovery.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Scale labels (same for all questions):

0 – Not at all

1 – A little

2 – Somewhat

3 – Mostly

4 – Very true
I feel emotionally stable most days

0 – Not at all1 – A little2 – Somewhat3 – Mostly4 – Very true
I am coping with post-surgery changes

0 – Not at all1 – A little2 – Somewhat3 – Mostly4 – Very true
I feel overwhelmed by recovery demands (reverse scored)

0 – Not at all1 – A little2 – Somewhat3 – Mostly4 – Very true
I can manage difficult emotions without turning to food

0 – Not at all1 – A little2 – Somewhat3 – Mostly4 – Very true
I feel supported during my recovery

0 – Not at all1 – A little2 – Somewhat3 – Mostly4 – Very true
I feel anxious or distressed about my progress (reverse scored)

0 – Not at all1 – A little2 – Somewhat3 – Mostly4 – Very true
I feel mentally prepared to continue my recovery

0 – Not at all1 – A little2 – Somewhat3 – Mostly4 – Very true
Disclaimer:

This questionnaire supports your wellbeing under the care of your counsellor, Desanka Ogrizovic, in collaboration with Dr Mo Atalla and the BetterLife Surgery team.

Your responses will be assessed, and a summary report shared with you and the team. This is not a diagnostic tool and does not replace professional assessment.
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6-Week Post-Bariatric Emotional Stability Check