Dr Fab - Wellbeing Questionnaire

Instructions: Please consider how you have generally felt during the past 2 weeks and rate each statement from 0 to 5.

0 = Not at all / Very poor
1 = Rarely / Poor
2 = Occasionally / Below average
3 = Often / Average
4 = Most of the time / Good
5 = Consistently / Very good

Your personal information will remain private.
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Name

First NameLast Name

Age

Email

example@example.com

Sex

Other

Energy and Daily Function

1. I have had enough energy to get through my usual daily activities.

2. I have felt alert and awake during the day.

3. I have generally felt physically refreshed rather than tired or drained.

Sleep

4. I have been able to fall asleep without significant difficulty.

5. I have been able to stay asleep through the night without frequent awakenings.

6. I have generally felt rested when waking up.

Mood and Emotional Wellness

7. I have generally felt calm and free from excessive worry or nervousness.

8. I have generally felt positive and emotionally well, rather than sad or low.

9. I have felt motivated and interested in my usual activities.

10. I have been able to enjoy positive experiences and activities.

11. I have generally started my day in a positive or comfortable mood.

12. I have felt emotionally comfortable with myself, without frequent feelings of guilt or self-criticism.

Appetite and Digestive Wellness

13. My appetite has felt normal and balanced.

14. I have been comfortable with my eating patterns, including during the evening and nighttime.

15. My stomach and digestion have generally felt comfortable after eating.

16. My bowel movements have generally felt regular and comfortable.

Physical Comfort and Body Regulation

17. My hands and feet have generally felt comfortably warm.

18. My body temperature and sweating during sleep have generally felt comfortable and normal for me.

19. My heartbeat has generally felt steady and comfortable when I am resting.

Overall Wellness

20. Overall, I have felt physically and emotionally well.

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Your personal information will remain private.

Total Score

General Wellness Questionnaire