Mental Health Check-In Survey

Mental Health Check-In Survey — Form Fields

This surveys template includes 7 fields. A compassionate anonymous survey to gauge emotional wellbeing, stress levels, and coping strategies. Free to customize and use on ZenBuild.

• Overall, how would you rate your mental wellbeing this past week? (rating, required)
• How often have you felt stressed or overwhelmed in the past two weeks? (multiple choice, required) — options: Not at all, A few days, More than half the days, Nearly every day
• Which of the following have you experienced recently? (Select all that apply) (checkboxes, optional) — options: Difficulty sleeping, Feeling anxious or worried, Low mood or sadness, Difficulty concentrating, Feeling disconnected or isolated, None of the above
• Which coping strategies do you use when feeling stressed? (checkboxes, optional) — options: Exercise or physical activity, Talking to friends or family, Meditation or mindfulness, Journaling, Professional counseling or therapy, Hobbies or creative outlets, I don't have effective coping strategies
• How supported do you feel by the people around you? (rating, required)
• Have you sought professional mental health support in the past year? (multiple choice, optional) — options: Yes, and it has been helpful, Yes, but with limited benefit, No, but I'd like to, No, and I don't feel I need to, Prefer not to say
• Is there anything else you'd like to share about your wellbeing or what support you need? (long text, optional)