Name* First Last Email* Mobile*Since your last check-up at the clinic, have you experienced any problems personally with:Sleep* Yes No Sleep CommentAppetite* Yes No Appetite CommentMood* Yes No Mood CommentEnergy* Yes No Energy CommentAnxiety* Yes No Anxiety CommentStressful Events* Yes No Stressful Events CommentSubstance Use* Yes No Substance Use CommentSince your last review, have you had any changes in your own mental health or mental health treatment? Yes No Mental Health CommentCurrent medications / health problems, if any: DASS 21DASS 21 was developed by the University of NSW. http://www.psy.unsw.edu.au/dass/Please read each statement and indicate how much the statement applied to you over the last week. There are no right or wrong answers. Do not spend too much time on any statement. The rating scale is as follows: NEVER – Did not apply to me at all SOMETIMES – Applied to me to some degree, or some of the time OFTEN – Applied to me to a considerable degree, or a good amount of the time ALMOST ALWAYS – Applied to me very much, or most of the timeI found it hard to wind down* NEVER SOMETIMES OFTEN ALMOST ALWAYS I was aware of dryness of my mouth* NEVER SOMETIMES OFTEN ALMOST ALWAYS I couldn't seem to experience any positive feeling at all* NEVER SOMETIMES OFTEN ALMOST ALWAYS I experienced breathing difficulty (eg, excessively rapid breathing, breathlessness in the absence of physical exertion)* NEVER SOMETIMES OFTEN ALMOST ALWAYS I found it difficult to work up the initiative to do things* NEVER SOMETIMES OFTEN ALMOST ALWAYS I tended to over-react to situations* NEVER SOMETIMES OFTEN ALMOST ALWAYS I experienced trembling (eg, in the hands)* NEVER SOMETIMES OFTEN ALMOST ALWAYS I felt that I was using a lot of nervous energy* NEVER SOMETIMES OFTEN ALMOST ALWAYS I was worried about situations in which I might panic and make a fool of myself* NEVER SOMETIMES OFTEN ALMOST ALWAYS I felt that I had nothing to look forward to* NEVER SOMETIMES OFTEN ALMOST ALWAYS I found myself getting agitated* NEVER SOMETIMES OFTEN ALMOST ALWAYS I found it difficult to relax* NEVER SOMETIMES OFTEN ALMOST ALWAYS I felt down-hearted and blue* NEVER SOMETIMES OFTEN ALMOST ALWAYS I was intolerant of anything that kept me from getting on with what I was doing* NEVER SOMETIMES OFTEN ALMOST ALWAYS I felt I was close to panic* NEVER SOMETIMES OFTEN ALMOST ALWAYS I was unable to become enthusiastic about anything* NEVER SOMETIMES OFTEN ALMOST ALWAYS I felt I wasn't worth much as a person* NEVER SOMETIMES OFTEN ALMOST ALWAYS I felt that I was rather touchy* NEVER SOMETIMES OFTEN ALMOST ALWAYS 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)* NEVER SOMETIMES OFTEN ALMOST ALWAYS I felt scared without any good reason* NEVER SOMETIMES OFTEN ALMOST ALWAYS I felt that life was meaningless* NEVER SOMETIMES OFTEN ALMOST ALWAYS