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Monthly Well Being Check-in 7

This is a brief survey that helps helps people see if they may be experiencing symptoms of anxiety and notice any changes over time. We use it to better understand the mental health needs of the people we work with and connect them to the right help or resources. Looking at the results also helps us see how our program is working, how to make improvements and show our impact to people who may want to support our work.

 

All responses are kept strictly confidential and will not be shared outside of our organization.

Feeling nervous, anxious or on edge
Not at all
Several days this month
More than half of the days this month
Nearly ever day this month
Not being able to stop or control worrying
Not at all
Several days this month
More than half of the days this month
Nearly ever day this month
Worrying too much about different things
Not at all
Several days this month
More than half of the days this month
Nearly ever day this month
Trouble relaxing
Not at all
Several days this month
More than half of the days this month
Nearly ever day this month
Being so restless that it is hard to sit still
Not at all
Several days this month
More than half of the days this month
Nearly ever day this month
Becoming easily annoyed or irritable
Not at all
Several days this month
More than half of the days this month
Nearly ever day this month
Feeling afriad, as if something bad might happen
Not at all
Several days this month
More than half of the days this month
Nearly ever day this month

Mosaic Advocacy is an equal opportunity organization and does not discriminate based upon ethnicity, race,

gender, religion, disability, age, sexual orientation, national origin, socioeconomic background or any other status.

Mosaic Advocacy is a registered 501(c)3 nonprofit.

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