This seven-question form opens by asking patients to rate their overall psychological well-being and current stress level on a five-point scale, giving the healthcare provider two quick numerical anchors before diving deeper. It then asks the "Which of the following best describes your current mood?" question to capture the patient's emotional state at the time of filling in the form, followed by three open-ended questions covering sleep patterns, coping strategies, and recent life changes — each designed to surface context that a rating alone cannot provide. The "Have you experienced symptoms of anxiety or depression recently?" question acts as a clinical flag, helping the provider prioritise follow-up. After submitting, patients see a confirmation screen thanking them and noting that their responses will be reviewed by their healthcare provider.
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Rely on the paired well-being and stress rating questions to quickly triage a patient's mental health before a consultation.
Use the open-ended sleep, coping, and life-changes questions to gather narrative context that informs session planning.
Depend on the "Have you experienced symptoms of anxiety or depression recently?" question as a standardised flag for referral decisions.
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