Step 1 of 37 2% For whom are you doing this assessment? Individual (for myself) Couples (for myself and my partner) Teen (for my child) 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 HiddenCouple form starts What type of issues do you want to overcome in your relationship? Improve our communication Decide whether we should separate Resolve conflicts Overcome adultery Understand myself better Understand my partner better Get to a more fair workload Reduce tension Prevent separation or divorce Learn "good" ways to fight Stop hurting each other Win back my partner's love Love my partner again Discuss issues around raising kids Improve our sex and intimacy Divorce or separation mediation What gender do you most identify with? Male Female Gay/Lesbian/Trans/Other How Old Are You?Select Your age18192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899 Do you Currently live with your partner Yes No Is domestic violence currently an issue in your relationship? Yes No Sometime How would you rate current financial status? Good Fair Bad Would you trust this person with your life? Not at all Moderately Very Much Do you think that you could easily live without this person if your paths were to part? Yes No Do you think about him/her regularly throughout the day, missing his/her company whenever s/he is not around? Not at all Moderately Very Much Is there a single thing about this person that irritates or annoys you from time to time? Yes No Do both of you share a sense of humor and laugh together easily over jokes which might not seem particularly funny if someone else said them? Not At All Moderately Very Much HiddenCouple form EndsHiddenChild form starts How old is your child?Select Your age11121314151617181920 What is the gender of your child? Male Female Non-Binary How are you related to your child? I am the mother I am the father I am the legal guardian Other Where does your child live? With both his parents With me only With other parent Other Does your child go to school? Yes, Regularly Yes, but he skips some classes No Based on your Observations:How do you rate your child current sleeping habits? Good Fair Poor How would you rate your relationship with your child? Good Fair Poor Is your child currently experiencing anxiety, panic attacks or have any phobias? Yes No Is your child currently experiencing overwhelming sadness, grief or depression? Yes No Over the past 2 weeks, how often have you observed that your child has been bothered by any of the following problems:Having anger outbursts, yelling and screaming or being violent towards others. Not at all Several days More than half the days Nearly every day Trouble Concentrating on things, such as having a conversation or watching television? Not at all Several days More than half the days Nearly every day When was the last time your child thoughts about suicide? Never Over an year ago Over 3 months ago In the last 3 months Do you have concerns about your child in any of these issues? Relationship with family /peers Coping with life changes ADHD /ADD School Challenges Criminal behaviour Substance abuse Sexuality-related issues Almost done! Please enter your details to get the results.Name Email HiddenYour Anxiety ScoreHiddenYour Depression ScoreHiddenYour Stress ScoreHiddenOverall Mental HealthAnxiety Level: None Anxiety Level: Mild Anxiety Level: Moderate Anxiety Level: Severe HiddenLow Anxiety text HiddenMild Anxiety text HiddenModerate Anxiety text HiddenSevere Anxiety text Depression Level: None Depression Level: Mild Depression Level: Moderate Depression Level: Severe HiddenLow Depression Text HiddenMild Depression Text HiddenModerate Depression Text HiddenSevere Depression Text Stress Level: None Stress Level: Mild Stress Level: Moderate Stress Level: Severe HiddenLow Stress Text HiddenMild Stress Text HiddenModerate Stress Text HiddenSevere Stress Text Overall Emotional Health : Healthy Overall Emotional Health : Mild Overall Emotional Health : Moderate Overall Emotional Health : Severe HiddenLow Overall Text HiddenMild Overall Text HiddenModerate Overall Text HiddenSevere Overall Text Summary Your assessment results suggest that you have A Healthy State of MindSummary 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. HiddenCouple form Result HiddenCouple Score Your assessment suggests that you have a fine relationship. We suggest further evaluation by counselor or therapist. Your assessment suggests that you are facing Moderate Relationship issues. We suggest further evaluation by counselor or therapist. Your assessment suggests that you are facing Severe Relationship issues. We suggest further evaluation by counselor or therapist.HiddenTeen form Result HiddenTeen Score Your responses suggest that your child doesn't have emotional wellbeing issues. We suggest further evaluation by counselor or therapist. Your responses suggest that your child has moderate emotional wellbeing issues. We suggest further evaluation by counselor or therapist. Your responses suggest that your child has severe emotional wellbeing issues. We suggest further evaluation by counselor or therapist. Copyright © 2024 Mantra | All Rights Reserved | Terms of Use | Refund Policy | Privacy Policy
