Enhanced Mental Health Check-In Form 1 Personal Info 2 Daily Check-In 3 Mental Health Overview 4 Self-Reflection & Growth 5 Positive Reflection 6 Relational Insights & Self-Reflection 7 Review & Submit 8 Thank You Personal Information First Name Last Name Email Next Daily Check-In Overall Mood Today: 5/10 Stress Levels: 5/10 Sleep Quality: 5/10 Energy Levels: 5/10 Previous Next Mental Health Overview Do you feel anxious? Select an option Never Sometimes Often Always Do you experience feelings of depression? Select an option Never Sometimes Often Always How focused do you feel during your day? Select an option Very Distracted Somewhat Distracted Neutral Focused Very Focused Previous Next Self-Reflection & Growth What’s something you’ve been avoiding dealing with? In what areas of your life are you evolving, and where do you feel stuck? Choose Your Strengths: Choose Your Weaknesses: What personal boundary do you need to set this week? Previous Next Positive Reflection If you find yourself feeling avoidant, what actions or strategies could you employ to address this behavior? In moments when you experience anxiety, what techniques or practices could you use to manage it effectively? When you seek to improve your focus during tasks, what methods or approaches could you adopt? If you aim to enhance your mental health, which support systems or resources could you utilize? Previous Next Relational Insights & Self-Reflection How do you typically handle stress in relationships? Select an option I avoid addressing it. I confront it directly. I seek support from others. I try to resolve it internally. How do you usually respond to conflict in relationships? Select an option Avoidance Open confrontation Seeking mediation or help Trying to defuse the situation Which of the following patterns do you often notice in your relationships? Select an option Seeking approval from others Difficulty trusting people Conflict avoidance Over-communicating to prevent misunderstandings How do you prefer to seek emotional support? Select an option I rely on a close group of friends or family. I prefer to handle my emotions on my own. I seek professional help (therapy, counseling). I avoid seeking emotional support. Previous Next Review & Submit Please review your information before submitting. Smart Recap Your Strengths and Weaknesses Diagram Download Diagram Generate Recap & Diagram Previous Submit Thank You! Your check-in has been submitted successfully. Start Over
