• Welcome to Rehab Management's Mental Health & Wellbeing Screen. Your health is important to us, so we request that all information is filled out to the best of your ability. This will assist us to guide any future coaching program.

    We hold all your responses in the strictest of confidence. At Rehab Management we aim to build trust through meaningful interactions and we look forward to reviewing your results upon completion of the screen.

    Please read each statement and enter 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.

    The rating scale is as follows:

    0 - Did not apply to me at all
    1 - Applied to me to some degree, or some of the time
    2 - Applied to me to a considerable degree or good part of time
    3 - Applied to me very much or most of the time

    All fields marked with an * are mandatory.

    Completion of the screen will only occur once you click the submit button. If you decide not to finish and/or not to submit the screening your responses will be lost and deleted from the system.

  • Gender*
  • Department*
  • Location*

  • Please input a valid mobile number and click Confirm. A SMS validation code will be sent to your mobile. Enter the validation code and click Confirm.

  •   Please ensure the phone number does not start with a '0' (zero) e.g. +61444444444  

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  • The rating scale is as follows:

    0 - Did not apply to me at all
    1 - Applied to me to some degree, or some of the time
    2 - Applied to me to a considerable degree or good part of time
    3 - Applied to me very much or most of the time

  • I found it hard to wind down*
  • I was aware of dryness of my mouth*
  • I couldn’t seem to experience any positive feeling at all*
  • I experienced breathing difficulty (e.g. excessively rapid breathing, breathlessness in the absence of physical exertion)*
  • I found it difficult to work up the initiative to do things*
  • I tended to over-react to situations*
  • I experienced trembling (e.g. in the hands)*
  • I felt that I was using a lot of nervous energy*
  • I was worried about situations in which I might panic and make a fool of myself*
  • I felt that I had nothing to look forward to*
  • I found myself getting agitated*
  • I found it difficult to relax*

  • The rating scale is as follows:

    0 - Did not apply to me at all
    1 - Applied to me to some degree, or some of the time
    2 - Applied to me to a considerable degree or good part of time
    3 - Applied to me very much or most of the time

  • I felt down-hearted and blue*
  • I was intolerant of anything that kept me from getting on with what I was doing*
  • I felt I was close to panic*
  • I was unable to become enthusiastic about anything*
  • I felt I wasn’t worth much as a person*
  • I felt that I was rather touchy*
  • 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)*
  • I felt scared without any good reason*
  • I felt that life was meaningless*
  • Awareness. Do you believe your awareness of your health and wellbeing has improved as a result of this program?*
  • Action. Have you taken action to improve your heath and wellbeing as a result of this program?*
  • Future. Do you feel more confident to self manage your health and wellbeing in the future as a result of your participation in this program?*
  • Should be Empty: