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* 1. Would you say that your general overall combined physical & mental health is:

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* 2. Now thinking specifically about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days were you unable to do your usual activities, such as self-care, work or recreation?

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* 3.  I have a good understanding of what my mental health issues are:

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* 4. I currently feel that I have coping strategies to deal with my mental health issues:

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* 5. Comments:

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