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Sharing Group Wellbeing Assessment Form
Name
*
First
Last
Email
*
Below are some statements about feelings and thoughts. Please choose the answer that best describes your experience of each over the last two weeks.
I’ve been feeling optimistic about the future
*
None of the time
Rarely
Some of the time
Often
All of the time
I’ve been feeling useful
*
None of the time
Rarely
Some of the time
Often
All of the time
I’ve been feeling relaxed
*
None of the time
Rarely
Some of the time
Often
All of the time
I’ve been dealing with problems well
*
None of the time
Rarely
Some of the time
Often
All of the time
I’ve been thinking clearly
*
None of the time
Rarely
Some of the time
Often
All of the time
I’ve been feeling close to other people
*
None of the time
Rarely
Some of the time
Often
All of the time
I’ve been able to make up my mind about things
*
None of the time
Rarely
Some of the time
Often
All of the time
Below are some more questions about feelings. Please give a score of 0 to 10 where 0 means extremely dissatisfied/ unhappy or not at all anxious/ worthwhile and 10 means extremely satisfied/ happy/ anxious/ worthwhile.
Overall, how satisfied are you with your life nowadays?
*
0
1
2
3
4
5
6
7
8
9
10
Overall, how happy did you feel yesterday?
*
0
1
2
3
4
5
6
7
8
9
10
Overall, how anxious did you feel yesterday?
*
0
1
2
3
4
5
6
7
8
9
10
Overall, to what extent do you feel the things you do in your life are worthwhile?
*
0
1
2
3
4
5
6
7
8
9
10
Social Trust Question: Generally speaking, would you say that most people can be trusted, or that you can’t be too careful in dealing with people? Please give a score of 0 to 10, where 0 means you can’t be too careful and 10 means that most people can be trusted.
*
0
1
2
3
4
5
6
7
8
9
10
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