EN - Mental health assessment (#32)

First name

Last name

Adjust the slider below so that you agree with the following statement on a scale of 0 to 10, where 10 means that you absolutely agree and 0 means that you absolutely disagree.

I excel in a variety of activities; difficulties in life never seem to get out of hand

I am interested in and involved in a wide range of activities in life (work, hobbies, social life, etc.).

I experience myself as being socially competent

I am generally satisfied with my life

Are you currently having psychiatric treatment?

Yes

Please enter the details (name and address) of your psychiatrist.

Please indicate how often you see your psychiatrist.

Are you currently taking prescription psychiatric medication?

Yes

Please indicate which medication you are taking for which symptoms.

Do you engage in illegal activities?

Often

Occasionally

Rarely

Never

INTAKE

Psychological symptoms and intensity