Assessment Form

Step 1 of 20

Are you Facing Any These Challenges?*

ADHD

Abuse

Anger

Anxiety

Body image

Depression

Eating Disorder

Family

Grief/loss

Gender Identity

Insomnia

OCD

Panic Attacks

Relationship

Self-esteem

Sexuality

Stress

Trauma / PTSD

Work

Other

Feeling nervous, anxious or on edge?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Not being able to stop or control worrying?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Trouble relaxing?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Being so restless that it is hard to sit still?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Becoming easily annoyed or irritable?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Feeling afraid as if something awful might happen?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Little interest or pleasure in doing things?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Feeling down, depressed, or hopeless?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Trouble falling or staying asleep, or sleeping too much?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Feeling tired or having little energy?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Poor appetite or overeating?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Feeling bad about yourself – or that you are a failure or have let yourself or your family down?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Trouble concentrating on things, such as reading the newspaper or watching television?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Thoughts that you would be better off dead, or of hurting yourself in some way?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Feeling Stressed, burdened or hassled?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Do you suffer from any of the following health conditions??

None

Hypertension

Diabetes

PCOS/PCOD

Physical pain

Weight issues

Thyroid

Others

Almost done! Please enter your details to get the results.

Name

Email*

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country

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Your Anxiety Score

Anxiety Level: None

Anxiety Level: Mild

Anxiety Level: Moderate

Anxiety Level: Severe

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Low Anxiety text

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Mild Anxiety text

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Moderate Anxiety text

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Severe Anxiety text

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Your Depression Score

Depression Level: None

Depression Level: Mild

Depression Level: Moderate

Depression Level: Severe

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Low Depression Text

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Mild Depression Text

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Moderate Depression Text

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Severe Depression Text

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Your Stress Score

Stress Level: None

Stress Level: Mild

Stress Level: Moderate

Stress Level: Severe

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Low Stress Text

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Mild Stress Text

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Moderate Stress Text

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Severe Stress Text

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Overall Mental Health

Overall Emotional Health : Healthy

Overall Emotional Health : Mild

Overall Emotional Health : Moderate

Overall Emotional Health : Severe

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Low Overall Text

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Mild Overall Text

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Moderate Overall Text

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Severe Overall Text

Free Emotional Assessment

Anxiety Level: None

Anxiety Level: Mild

Anxiety Level: Moderate

Anxiety Level: Severe

Depression Level: None

Depression Level: Mild

Depression Level: Moderate

Depression Level: Severe

Stress Level: None

Stress Level: Mild

Stress Level: Moderate

Stress Level: Severe

Overall Emotional Health : Healthy

Overall Emotional Health : Mild

Overall Emotional Health : Moderate

Overall Emotional Health : Severe

Summary

Your assessment results suggest that you have A Healthy State of Mind

Summary

Your assessment results suggest that you have Mild Emotional health issues. We suggest further evaluation by counselor or therapist.

Summary

Your assessment results suggest that you have Moderate Emotional health issues. We suggest further evaluation by counselor or therapist.

Summary

Your assessment results suggest that you have Severe Emotional health issues. We suggest further evaluation by counselor or therapist.