Templates Health & Wellness Medical Depression Self-Assessment Form Template

Depression Self-Assessment Form Template

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Personal Information

General Health Information

Depression Screening Questions

Lifestyle and Well-being Questions

Selected Value: 0

The Depression Self-Assessment Form Template by WPForms is a powerful tool for health organizations, therapists, and wellness initiatives seeking to provide a self-help resource for those questioning their mental health status.

How Does the Depression Self-Assessment Form Template Work?

The Depression Self-Assessment Form Template requires the WPForms Pro License and the Survey and Polls Addon to conduct a mental health evaluation accurately and plot responses into visual charts and graphs. Fields include:

  • Personal Information:
    • Name: Initiates a personal connection by asking for the individual’s name.
    • Age: Age is crucial as it helps understand the context of the responses.
    • Email: For follow-up communication with resources or support as needed.
    • Phone: Offers an alternative means of contact in case of emergencies.
  • General Health Information:
    • Do you have any chronic illnesses? Understanding physical health conditions that might influence or exacerbate depression symptoms.
    • Are you currently on any medication? Medications can affect mood and emotional state, making this info vital for a detailed assessment.
  • Depression Screening Questions:
    • 9 Questions: A set of carefully crafted questions aimed at gauging the severity and presence of depression symptoms.
    • How would you rate your overall stress level on a scale of 1 to 10? This scale provides a quick snapshot of the individual’s current state.
    • Do you have a support system (friends, family, etc.)? Understanding the individual’s support network is critical for assessing resilience.
    • Follow-Up Consent: Ensures that respondents are comfortable with being contacted for further support or information.

Sign up with WPForms today and access the Depression Self-Assessment Form Template to provide a valuable resource for those struggling in silence and offer an open line of communication to professional care.