Phone DASS 21 Followup Questionnaire Your First Name * Your Last Name * Todays Date * Please read each statement and select which most applied to you over the last week. There is no right or wrong answers. do not spend too much time on any statement. 1. I found it hard to wind down. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 2. I was aware of dryness of my mouth. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 3. I couldn't seem to experience any positive feeling at all. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 4. I experienced breathing difficulty (e.g. excessively rapid breathing, breathlessness in the absence of physical exertion) * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 5. I found it difficult to work up the initiative to do things. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 6. I tended to over-react to situations. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 7. I experienced trembling (e.g. in the hands) * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 8. I felt that I was using a lot of nervous energy. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 9. I was worried about situations in which I panic and make a fool of myself. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 10. I felt that I had nothing to look forward to. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 11. I found myself getting agitated. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 12. I found it difficult to relax. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 13. I felt down-hearted and blue. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 14. I was intolerant of anything that kept me from getting on with what I was doing. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 15. I felt I was close to panic. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 16. I was unable to become enthusiastic about anything. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 17. I felt I wasn't worth much as a person. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 18. I felt that I was rather touchy. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 19. I was aware of the action of my heart in the absence of physical exertion (e.g. sense of heart rate increase, heart missing a beat) * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 20. I felt scared without any good reason. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always 21. I felt that life was meaningless. * Please select the appropriate response from the drop down menu. 0. Never 1. Sometimes 2. Often 3. Almost Always Depression totals Total D: Anxiety totals Total A: Stress totals Total S: Comments / Questions Your feedback is important to us as it allows us to provide the best quality care and service for you the client. Please take a moment to fill in the following survey. YesNo Thank you for taking the time to complete the questionnaires. recaptcha
