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DASS21
*
Indicates required field
Name
*
DOB
*
Today's Date
*
Please read each statement and circle a number 0, 1, 2 or 3 which indicates how much the statement applied to you
over the past week
. There are no right or wrong answers. Do not spend too much time on any statement.
1. I found it hard to wind down
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of time
3 Applied to me very much, or most of the time
2. I was aware of dryness of my mouth
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
3. I couldn't seem to experience any positive feeling at all
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
4. I experienced breathing difficulty (eg, excessively rapid breathing, breathlessness in the absence of physical exertion)
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
5. I found it difficult to work up the initiative to do things
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
6. I tended to over-react to situations
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
7. I experienced trembling (eg, in the hands)
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
8. I felt that I was using a lot of nervous energy
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
9. I was worried about situations in which I might panic and make a fool of myself
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
10. I felt that I had nothing to look forward to
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
11. I found myself getting agitated
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
12. I found it difficult to relax
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or good part of the time
3 Applied to me very much, or most of the time
13. I felt down-hearted and blue
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or good part of the time
3 Applied to me very much, or most of the time
14. I was intolerant of anything that kept me from getting on with what I was doing
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or good part of the time
3 Applied to me very much, or most of the time
15. I felt I was close to panic
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or good part of the time
3 Applied to me very much, or most of the time
16. I was unable to become enthusiastic about anything
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or good part of the time
3 Applied to me very much, or most of the time
17. I felt I wasn't worth much as a person
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or good part of the time
3 Applied to me very much, or most of the time
18. I felt that I was rather touchy
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or good part of the time
3 Applied to me very much, or most of the time
19. I was aware of the action of my heart in the absence of physical exertion (eg, sense of heart rate increase, heart missing a beat)
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or good part of the time
3 Applied to me very much, or most of the time
20. I felt scared without any good reason
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or good part of the time
3 Applied to me very much, or most of the time
21. I felt that life was meaningless
*
0 Did not apply to me
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or good part of the time
3 Applied to me very much, or most of the time
Submit
Home
About
Our Promise
Join our Amazing Team
Fees
Meet the Angels
Psychology/Social Work
>
Individual Counselling
Children and Adolescent Counselling
Couples Counselling
How you Can Access Us
Services
Resources
Store
Blog
Contact
Appointment Request form
Change of details
Consent form
Upload your Mental Health Care Plan Here
