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

Excellent

Very good

Good

Fair

Poor

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?

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

Definitely

For the most part

Somewhat

Not really

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

Definitely

For the most part

Somewhat

Not really

5.Comments: