SWEMWBS - Groups - Referrals - Mind CHWF

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Home > SWEMWBS – Groups – Referrals

Please fill this form out

Full Name

Referral ID

Please copy and paste the Referral ID. This is a combination of letters and numbers provided by your facilitator. It looks like this: 0064J00000JdBoe

Group ID

Please copy and paste the Group ID. This is a combination of letters and numbers provided by your facilitator. It looks like this: 0064J00000JdBoe

Type

Between the first and the last intervention please select "Mid Event"

Below are some statements about feelings and thoughts.

Please enter the number that best describes your experience of each over the last 2 weeks based on the below:

= None of the time
= Rarely
= Some of the time
= Often
= All of the time

I have been feeling optimistic about the future

Please enter a number from 1 to 5.

I have been feeling useful

Please enter a number from 1 to 5.

I have been feeling relaxed

Please enter a number from 1 to 5.

I've been dealing with problems well

Please enter a number from 1 to 5.

I've been thinking clearly

Please enter a number from 1 to 5.

I've been feeling close to other people

Please enter a number from 1 to 5.

I've been able to make up my own mind about things

Please enter a number from 1 to 5.