Mental Health Check-in
This compassionate mental health check-in form helps individuals and organizations track emotional wellbeing over time. The form uses gentle emoji-based mood assessment, stress and energy level sliders, and conditional follow-up questions to understand contributing factors. Designed to be non-clinical and approachable, it's ideal for regular wellness check-ins, therapy progress tracking, or employee assistance programs.
Try the Form
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export function mentalHealthCheckinSurvey(form: FormTs) {
// Mental Health Check-in - Mood and Wellness Tracking Form
// Demonstrates: EmojiRating (mood preset), Slider, conditional visibility, dynamic styling, supportive messaging
// ============================================
// HEADER
// ============================================
form.addRow(row => {
row.addTextPanel('header', {
label: 'Mental Health Check-in',
computedValue: () => 'Take a moment to reflect on how you\'re feeling. Your wellbeing matters.',
customStyles: {
backgroundColor: '#6366f1',
color: 'white',
padding: '24px',
borderRadius: '12px',
textAlign: 'center'
}
});
});
// ============================================
// SECTION 1: Current Mood
// ============================================
const moodSection = form.addSubform('moodSection', {
title: 'How Are You Feeling Right Now?',
customStyles: () => {
const mood = moodSection.emojiRating('currentMood')?.value();
if (mood === 'excited' || mood === 'happy') {
return { backgroundColor: '#d1fae5', padding: '16px', borderRadius: '8px' };
}
if (mood === 'sad' || mood === 'down') {
return { backgroundColor: '#ede9fe', padding: '16px', borderRadius: '8px' };
}
return { backgroundColor: '#f8fafc', padding: '16px', borderRadius: '8px' };
}
});
moodSection.addRow(row => {
row.addEmojiRating('currentMood', {
label: 'Select the emoji that best describes your mood:',
preset: 'mood',
size: 'lg',
showLabels: true,
alignment: 'center',
isRequired: true
});
});
// Dynamic supportive message based on mood
moodSection.addRow(row => {
row.addTextPanel('moodMessage', {
computedValue: () => {
const mood = moodSection.emojiRating('currentMood')?.value();
switch (mood) {
case 'excited':
return "That's wonderful! It's great to hear you're feeling excited and energized.";
case 'happy':
return "Nice! Feeling happy is something to appreciate. Let's capture what's going well.";
case 'neutral':
return "It's okay to feel neutral. Let's check in on a few more things.";
case 'down':
return "Thank you for sharing. It takes courage to acknowledge difficult feelings.";
case 'sad':
return "We're sorry you're feeling this way. Remember, it's okay to not be okay sometimes.";
default:
return '';
}
},
customStyles: () => {
const mood = moodSection.emojiRating('currentMood')?.value();
if (!mood) return { display: 'none' };
return {
padding: '12px',
borderRadius: '8px',
backgroundColor: mood === 'excited' || mood === 'happy' ? '#ecfdf5' :
mood === 'sad' || mood === 'down' ? '#f5f3ff' : '#f1f5f9',
fontStyle: 'italic',
textAlign: 'center',
marginTop: '8px'
};
},
isVisible: () => moodSection.emojiRating('currentMood')?.value() !== null
});
});
// ============================================
// SECTION 2: Energy & Stress Levels
// ============================================
const levelsSection = form.addSubform('levelsSection', {
title: 'Energy & Stress Levels',
isVisible: () => moodSection.emojiRating('currentMood')?.value() !== null
});
levelsSection.addRow(row => {
row.addSlider('energyLevel', {
label: 'How is your energy level today?',
min: 1,
max: 10,
step: 1,
defaultValue: 5,
showValue: true,
unit: '/10'
}, '1fr');
row.addSlider('stressLevel', {
label: 'How stressed are you feeling?',
min: 1,
max: 10,
step: 1,
defaultValue: 5,
showValue: true,
unit: '/10'
}, '1fr');
});
levelsSection.addRow(row => {
row.addSlider('sleepQuality', {
label: 'How well did you sleep last night?',
min: 1,
max: 10,
step: 1,
defaultValue: 5,
showValue: true,
unit: '/10'
}, '1fr');
row.addSlider('anxietyLevel', {
label: 'How anxious are you feeling?',
min: 1,
max: 10,
step: 1,
defaultValue: 5,
showValue: true,
unit: '/10'
}, '1fr');
});
// ============================================
// SECTION 3: Positive Factors (for positive moods)
// ============================================
const positiveSection = form.addSubform('positiveSection', {
title: 'What\'s Contributing to Your Good Mood?',
isVisible: () => {
const mood = moodSection.emojiRating('currentMood')?.value();
return mood === 'excited' || mood === 'happy';
},
customStyles: { backgroundColor: '#ecfdf5', padding: '16px', borderRadius: '8px' }
});
positiveSection.addRow(row => {
row.addSuggestionChips('positiveFactors', {
label: 'Select what\'s going well (choose all that apply):',
suggestions: [
{ id: 'accomplishment', name: 'Accomplished something' },
{ id: 'connection', name: 'Connected with others' },
{ id: 'exercise', name: 'Physical activity' },
{ id: 'outdoors', name: 'Time outdoors' },
{ id: 'hobby', name: 'Enjoyed a hobby' },
{ id: 'rest', name: 'Good rest/sleep' },
{ id: 'work', name: 'Work going well' },
{ id: 'mindfulness', name: 'Mindfulness/meditation' }
],
alignment: 'center'
});
});
positiveSection.addSpacer();
positiveSection.addRow(row => {
row.addTextarea('gratitude', {
label: 'What are you grateful for today?',
placeholder: 'Share one or more things you\'re thankful for...',
rows: 2,
autoExpand: true
});
});
// ============================================
// SECTION 4: Challenges (for difficult moods)
// ============================================
const challengesSection = form.addSubform('challengesSection', {
title: 'What\'s Affecting Your Mood?',
isVisible: () => {
const mood = moodSection.emojiRating('currentMood')?.value();
return mood === 'down' || mood === 'sad';
},
customStyles: { backgroundColor: '#f5f3ff', padding: '16px', borderRadius: '8px' }
});
challengesSection.addRow(row => {
row.addSuggestionChips('stressors', {
label: 'What factors are contributing? (Select all that apply):',
suggestions: [
{ id: 'work', name: 'Work stress' },
{ id: 'relationships', name: 'Relationship issues' },
{ id: 'health', name: 'Health concerns' },
{ id: 'finances', name: 'Financial worries' },
{ id: 'sleep', name: 'Poor sleep' },
{ id: 'isolation', name: 'Feeling isolated' },
{ id: 'uncertainty', name: 'Uncertainty/change' },
{ id: 'overwhelm', name: 'Feeling overwhelmed' }
],
alignment: 'center'
});
});
challengesSection.addSpacer();
challengesSection.addRow(row => {
row.addTextarea('challengeDetails', {
label: 'Would you like to share more about what\'s on your mind?',
placeholder: 'This is a safe space to express your thoughts...',
rows: 3,
autoExpand: true
});
});
// Support resources for low moods
challengesSection.addRow(row => {
row.addTextPanel('supportMessage', {
label: 'Support Resources',
computedValue: () => {
const mood = moodSection.emojiRating('currentMood')?.value();
if (mood !== 'sad') return '';
return 'Remember: It\'s okay to ask for help. Consider reaching out to a trusted friend, family member, or mental health professional. If you\'re in crisis, please contact a helpline in your area.';
},
customStyles: {
padding: '12px',
borderRadius: '8px',
backgroundColor: '#fef3c7',
borderLeft: '4px solid #f59e0b',
fontSize: '14px'
},
isVisible: () => moodSection.emojiRating('currentMood')?.value() === 'sad'
});
});
// ============================================
// SECTION 5: Coping & Self-Care
// ============================================
const copingSection = form.addSubform('copingSection', {
title: 'Self-Care Today',
isVisible: () => moodSection.emojiRating('currentMood')?.value() !== null
});
copingSection.addRow(row => {
row.addCheckboxList('selfCareActivities', {
label: 'Which self-care activities have you done today?',
options: [
{ id: 'exercise', name: 'Physical exercise' },
{ id: 'healthy-eating', name: 'Healthy eating' },
{ id: 'hydration', name: 'Stayed hydrated' },
{ id: 'social', name: 'Social connection' },
{ id: 'nature', name: 'Time in nature' },
{ id: 'rest', name: 'Rest/relaxation' },
{ id: 'mindfulness', name: 'Mindfulness/breathing' },
{ id: 'hobby', name: 'Enjoyed a hobby' },
{ id: 'none', name: 'None yet' }
],
orientation: 'vertical'
});
});
copingSection.addRow(row => {
row.addThumbRating('needsSupport', {
label: 'Would you like to speak with someone about how you\'re feeling?',
showLabels: true,
upLabel: 'Yes, please',
downLabel: 'Not right now',
alignment: 'left'
});
});
// Contact section if they need support
const contactSection = form.addSubform('contactSection', {
title: 'Contact Information',
isVisible: () => copingSection.thumbRating('needsSupport')?.value() === 'up',
customStyles: { backgroundColor: '#dbeafe', padding: '16px', borderRadius: '8px' }
});
contactSection.addRow(row => {
row.addTextPanel('contactNote', {
computedValue: () => 'A member of our wellness team will reach out to you. Your information is confidential.',
customStyles: {
fontSize: '14px',
color: '#1e40af',
marginBottom: '12px'
}
});
});
contactSection.addRow(row => {
row.addTextbox('preferredName', {
label: 'Preferred Name',
placeholder: 'How should we address you?',
isRequired: true
}, '1fr');
row.addEmail('contactEmail', {
label: 'Email Address',
placeholder: 'your@email.com',
isRequired: true
}, '1fr');
});
contactSection.addRow(row => {
row.addDropdown('contactPreference', {
label: 'Preferred contact method',
options: [
{ id: 'email', name: 'Email' },
{ id: 'phone', name: 'Phone call' },
{ id: 'video', name: 'Video call' },
{ id: 'in-person', name: 'In-person meeting' }
],
placeholder: 'Select your preference'
}, '1fr');
row.addDropdown('urgency', {
label: 'How soon would you like to connect?',
options: [
{ id: 'today', name: 'Today if possible' },
{ id: 'few-days', name: 'Within a few days' },
{ id: 'week', name: 'This week' },
{ id: 'flexible', name: 'Flexible' }
],
placeholder: 'Select'
}, '1fr');
});
// ============================================
// SECTION 6: Summary & Reflection
// ============================================
const summarySection = form.addSubform('summarySection', {
title: 'Check-in Summary',
isVisible: () => moodSection.emojiRating('currentMood')?.value() !== null
});
summarySection.addRow(row => {
row.addTextPanel('summaryContent', {
computedValue: () => {
const mood = moodSection.emojiRating('currentMood')?.value();
const energy = levelsSection.slider('energyLevel')?.value();
const stress = levelsSection.slider('stressLevel')?.value();
const sleep = levelsSection.slider('sleepQuality')?.value();
const anxiety = levelsSection.slider('anxietyLevel')?.value();
const selfCare = copingSection.checkboxList('selfCareActivities')?.value() || [];
if (!mood) return '';
const moodLabels: Record<string, string> = {
'excited': '🤩 Excited',
'happy': '😊 Happy',
'neutral': '😐 Neutral',
'down': '😔 Down',
'sad': '😢 Sad'
};
let summary = `Today's Check-in\n`;
summary += `${'═'.repeat(22)}\n\n`;
summary += `Mood: ${moodLabels[mood] || mood}\n\n`;
if (energy !== null && energy !== undefined) {
summary += `Energy: ${energy}/10 ${energy >= 7 ? '⚡' : energy <= 3 ? '🔋' : ''}\n`;
}
if (stress !== null && stress !== undefined) {
summary += `Stress: ${stress}/10 ${stress >= 7 ? '⚠️' : stress <= 3 ? '✨' : ''}\n`;
}
if (sleep !== null && sleep !== undefined) {
summary += `Sleep: ${sleep}/10 ${sleep >= 7 ? '😴' : sleep <= 3 ? '😫' : ''}\n`;
}
if (anxiety !== null && anxiety !== undefined) {
summary += `Anxiety: ${anxiety}/10 ${anxiety >= 7 ? '😰' : anxiety <= 3 ? '😌' : ''}\n`;
}
if (selfCare.length > 0 && !selfCare.includes('none')) {
summary += `\n✓ Self-care activities: ${selfCare.length}\n`;
}
// Add encouragement based on overall state
summary += `\n${'─'.repeat(22)}\n`;
if (mood === 'excited' || mood === 'happy') {
summary += `Keep nurturing what brings you joy!`;
} else if (mood === 'neutral') {
summary += `Small steps can shift your day.`;
} else {
summary += `Be gentle with yourself today.`;
}
return summary;
},
customStyles: () => {
const mood = moodSection.emojiRating('currentMood')?.value();
const baseStyles = {
padding: '16px',
borderRadius: '8px',
whiteSpace: 'pre-wrap',
fontFamily: 'monospace',
fontSize: '14px'
};
if (mood === 'excited' || mood === 'happy') {
return { ...baseStyles, backgroundColor: '#d1fae5', borderLeft: '4px solid #10b981' };
} else if (mood === 'neutral') {
return { ...baseStyles, backgroundColor: '#e0f2fe', borderLeft: '4px solid #3b82f6' };
} else {
return { ...baseStyles, backgroundColor: '#ede9fe', borderLeft: '4px solid #8b5cf6' };
}
}
});
});
// ============================================
// FORM CONFIGURATION
// ============================================
form.configureSubmitButton({
label: 'Complete Check-in',
isVisible: () => moodSection.emojiRating('currentMood')?.value() !== null
});
form.configureCompletionScreen({
type: 'text',
title: 'Thank You for Checking In',
message: 'Taking time to reflect on your mental health is an important act of self-care. Remember, every day is a new opportunity. Take care of yourself.'
});
}
Frequently Asked Questions
How often should mental health check-ins be done?
For therapeutic settings, weekly check-ins are common. For workplace wellness, monthly or bi-weekly works well. Daily check-ins can be valuable for individuals tracking their own patterns or during intensive treatment periods.
Is this form HIPAA compliant?
The form template itself doesn't collect identifiable data. HIPAA compliance depends on how you implement, store, and process the collected data. Consult with a compliance expert when using for healthcare purposes.
Can I customize this for my therapy practice?
Yes, you can modify questions, add custom mood scales, include specific therapeutic goals, or add sections relevant to your treatment approach. The conditional logic helps tailor follow-ups to individual responses.
How should I respond to concerning answers?
The form includes conditional support resources when low mood is detected. For professional settings, establish protocols for reviewing responses and following up. Always provide crisis hotline information where appropriate.
Can employees complete this anonymously?
Yes, the form can be configured to collect anonymous data for aggregate wellness insights. This helps organizations identify general wellbeing trends without identifying individuals.
What metrics should I track from these check-ins?
Key metrics include: average mood scores over time, stress level trends, energy patterns, frequently selected stressors, and correlation between factors. Look for patterns like weekly cycles or event-related changes.