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How have you been feeling emotionally over the past week?
⬜ Good
⬜ Okay
⬜ A bit overwhelmed
⬜ Struggling
How would you rate your current stress level?
⬜ Low
⬜ Moderate
⬜ High
How well are you sleeping lately?
⬜ Very well
⬜ Normal
⬜ Not great
⬜ Very poorly
Have you experienced frequent changes in mood recently?
⬜ Rarely
⬜ Sometimes
⬜ Often
Are your emotions affecting your work, studies, or daily life?
⬜ No
⬜ Occasionally
⬜ Yes, quite a bit
Do you feel you have someone to talk to when you’re stressed?
⬜ Yes
⬜ Somewhat
⬜ No
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