Mind Shape Trial Pre-Questionnaire

Please read carefully:

Below are some statements describing how people feel. Please select the response that indicates how you feel right now, at this moment. There are no right or wrong answers. Don’t spend too much time on any statement, just give the answer that best describes your present feelings.


Higher = more calm

1
Not at all

2
Slightly

3
Moderately

4
Very much

5
Extremely
Please select a response


Higher = more relaxed

1
Not at all

2
Slightly

3
Moderately

4
Very much

5
Extremely
Please select a response


Higher = more content

1
Not at all

2
Slightly

3
Moderately

4
Very much

5
Extremely
Please select a response


Higher = more mentally clear

1
Not at all

2
Slightly

3
Moderately

4
Very much

5
Extremely
Please select a response


Higher = more focused

1
Not at all

2
Slightly

3
Moderately

4
Very much

5
Extremely
Please select a response


Higher = more ready

1
Not at all

2
Slightly

3
Moderately

4
Very much

5
Extremely
Please select a response


Higher = better wellbeing

1
Very poor

2
Poor

3
Okay

4
Good

5
Very good
Please select a response


Higher = more stressed (note: this is opposite to questions above)

0
Not at all

1

2

3

4

5

6

7

8
Extremely
Please select a response

Please select a response


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