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Healthcare & Wellness
Mental Wellbeing Screening
A short, clinically-styled mood and anxiety screener counseling practices can send before a first session — gentle, private, and follow-up strictly opt-in.
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Preview · not interactiveMental Wellbeing Screening
A short, clinically-styled mood and anxiety screener counseling practices can send before a first session — gentle, private, and follow-up strictly opt-in.
This short check-in helps us understand how you have been feeling lately, so your first session starts in the right place. There are no right or wrong answers, your responses are kept confidential, and this is not a diagnosis — only a conversation starter. If you are in crisis or feel unsafe, please contact your local emergency or crisis support services right away.
Over the last two weeks, how often have you experienced…*
Not at allSeveral daysMore than half the daysNearly every dayLittle interest or pleasure in doing thingsFeeling down or hopelessFeeling nervous, anxious, or on edge
Overall, how would you rate your mood this week?*
What has been weighing on you most?
Select…▾
Would you like to say what it is?
Only if you want to — a word or two is enough.
Do you currently have someone you can talk to about how you feel?*
Yes
Not really
Would you like someone from the practice to reach out?*
Yes, please contact me
No thanks — just recording how I feel
Contact permission
Contact permission
Phone number (optional)
If you would rather we call
Submit