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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
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Join our Amazing Team
Services
>
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>
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Contact
Appointment Request form
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