#1
Mental health assesment

This questionnaire is designed to capture what are the detrimental symptoms you are currently experiencing, as well as an assessment of your current status.

Instructions

Try to be honest and connect with a personal part of yourself. Be as descriptive as possible. There are no right or wrong answers.

Personal information

First name

Last name

Symptoms

How would you describe your current life satisfaction?

In what area are you experiencing the most problems?

Describe the greatest detrimental symptoms you are experiencing.

Physical or psychological reactions that are unwanted and contribute to having a negative experience

What is the frequency of negative symptoms?

Status

How close do you feel to your maximum potential?

How confident are you that you can change your current status into a more positive direction?

Name three things you deeply care about and pay attention to.

How many deep supporters you currently have?

People that stand on your side and support you regardless of the circumstances

Name an unfair advantage you currently have.

A distinct competitive edge or skill that means an advantage for you in the market (examples: intelligence, language, economic advantage, place of origin)

Parent's history

How would you rate your parents in raising you?

What's are the biggest strengths and weaknesses you received from your childhood?

How would you describe your current relationship with your parents?

How would you rate your current relationship with your father?

How would you rate your current relationship with your mother?

Life goals

Imagining anything was possible, what would you like to accomplish?

What is your definition of work?

Exercise and levels of activity

How often do you exercise?

Gym or classes

How active are you on a daily basis?

Moving in general (i.e. not being in front of a desk or sitting)

Grit

How much mental grit would you say you currently have?

Name a scenario where you displayed grit

Name a scenario where you would have liked to have more mental grit

How much effort are you willing to invest in changing your life course?

#1 Mental health assesment