About this template
The DASS-21 (Depression, Anxiety, and Stress Scale) is a widely recognized self-report instrument designed to measure the negative emotional states of depression, anxiety, and stress. This Doc2Form template provides a structured, professional way for mental health practitioners to collect these critical insights from patients before an initial consultation or as part of routine progress monitoring.
By using this Google Form, clinicians can efficiently gather patient data, allowing for a more focused and productive clinical session. The form is designed to be clear and accessible, ensuring that patients can complete the assessment in a private environment. Once submitted, the data is automatically organized, enabling practitioners to quickly identify areas of concern and prioritize care based on the patient's reported symptoms.
Key features
- Standardized DASS-21 question set for clinical consistency.
- Clear rating scale for accurate symptom tracking.
- Mobile-responsive design for patient convenience.
- Easily export responses to Sheets for longitudinal analysis.
- Customizable to include clinic-specific intake instructions.
Use cases
- Initial intake assessments for new therapy patients.
- Routine mental health progress monitoring.
- Screening for clinical research or wellness programs.
- Telehealth pre-appointment patient data collection.
What this form collects
- Full Name (Short answer)Please provide your full legal name.
- Date (Date)Select the current date.
- I found it hard to wind down (Multiple choice)
- I was aware of dryness of my mouth (Multiple choice)
- I couldn't seem to experience any positive feeling at all (Multiple choice)
- I experienced breathing difficulty (Multiple choice)
- I found it difficult to work up the initiative to do things (Multiple choice)
- I tended to over-react to situations (Multiple choice)
- I experienced trembling (e.g., in the hands) (Multiple choice)
- I felt that I was using a lot of nervous energy (Multiple choice)
- I was worried about situations in which I might panic and make a fool of myself (Multiple choice)
- I felt that I had nothing to look forward to (Multiple choice)
- I found myself getting agitated (Multiple choice)
- I found it difficult to relax (Multiple choice)
- I felt down-hearted and blue (Multiple choice)
- I was intolerant of anything that kept me from getting on with what I was doing (Multiple choice)
- I felt I was close to panic (Multiple choice)
- I was unable to become enthusiastic about anything (Multiple choice)
- I felt I wasn't worth much as a person (Multiple choice)
- I felt that I was rather touchy (Multiple choice)
- I was aware of the action of my heart in the absence of physical exertion (Multiple choice)
- I felt scared without any good reason (Multiple choice)
- I felt that life was meaningless (Multiple choice)
FAQ
Can I score the DASS-21 automatically?
While Google Forms does not provide native clinical scoring, you can use Google Sheets formulas or add-ons to calculate the sum of the Depression, Anxiety, and Stress subscales automatically once the data is submitted.
How do I share this with my patients?
You can share the form via a direct link, embed it into a secure patient portal, or send it via email as part of your pre-appointment intake process.
Can I edit the questions?
Yes, once you copy this template to your Google Drive, you have full control to add, remove, or modify questions to better suit your specific clinical practice.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.