About this template
The Depression Anxiety Stress Scale (DASS-21) is a widely recognized set of three self-report scales designed to measure the emotional states of depression, anxiety, and stress. This DASS-21 Google Form template streamlines the intake and screening process for mental health professionals, clinics, and counselors by allowing clients to complete their assessments digitally prior to a session.
Using Doc2Form, you can instantly deploy this standardized 21-item questionnaire without worrying about manual data entry or complex setups. The form presents each statement clearly, prompting respondents to rate how much the statement applied to them over the past week using a standard severity scale.
By gathering these insights ahead of time, practitioners can better understand a client's baseline emotional state, track symptom changes over the course of treatment, and allocate session time more effectively. The clean layout ensures clients feel at ease while providing accurate, actionable information for your clinical practice.
Key features
- Standardized 21-item DASS format for reliable emotional state screening.
- Categorized prompts covering depression, anxiety, and stress symptoms.
- Clean, professional layout designed to put respondents at ease.
- Instant deployment via Google Forms with zero manual coding required.
Use cases
- Initial intake assessments for new therapy and counseling clients.
- Routine progress monitoring during ongoing mental health treatment.
- Telehealth pre-session check-ins for remote clinical practices.
- Research and academic studies tracking stress and anxiety levels.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Date (Date)Select today's date.
- I found it hard to wind down (Multiple choice)Rate how much this applied to you over the past week.
- I was aware of dryness of my mouth (Multiple choice)Rate how much this applied to you over the past week.
- I couldn't seem to experience any positive feeling at all (Multiple choice)Rate how much this applied to you over the past week.
- I experienced breathing difficulty (Multiple choice)For example, excessively rapid breathing, breathlessness in the absence of physical exertion.
- I found it difficult to work up the initiative to do things (Multiple choice)Rate how much this applied to you over the past week.
- I tended to over-react to situations (Multiple choice)Rate how much this applied to you over the past week.
- I experienced trembling (e.g., in the hands) (Multiple choice)Rate how much this applied to you over the past week.
- I felt that I was using a lot of nervous energy (Multiple choice)Rate how much this applied to you over the past week.
- I was worried about situations in which I might panic and make a fool of myself (Multiple choice)Rate how much this applied to you over the past week.
- I felt that I had nothing to look forward to (Multiple choice)Rate how much this applied to you over the past week.
- I found myself getting agitated (Multiple choice)Rate how much this applied to you over the past week.
- I found it difficult to relax (Multiple choice)Rate how much this applied to you over the past week.
- I felt down-hearted and blue (Multiple choice)Rate how much this applied to you over the past week.
- I was intolerant of anything that kept me from getting on with what I was doing (Multiple choice)Rate how much this applied to you over the past week.
- I felt I was close to panic (Multiple choice)Rate how much this applied to you over the past week.
- I was unable to become enthusiastic about anything (Multiple choice)Rate how much this applied to you over the past week.
- I felt I wasn't worth much as a person (Multiple choice)Rate how much this applied to you over the past week.
- I felt that I was rather touchy (Multiple choice)Rate how much this applied to you over the past week.
- I was aware of the action of my heart in the absence of physical exertion (Multiple choice)For example, sense of heart rate increase, heart missing a beat.
- I felt scared without any good reason (Multiple choice)Rate how much this applied to you over the past week.
- I felt that life was meaningless (Multiple choice)Rate how much this applied to you over the past week.
FAQ
What is the DASS-21?
The DASS-21 is a 21-item self-report questionnaire designed to measure the severity of a range of symptoms associated with depression, anxiety, and stress.
How do I use this template with Doc2Form?
Doc2Form instantly converts this template into a fully editable Google Form in your Google Drive, allowing you to start collecting responses immediately.
Can I customize the questions on this form?
Yes. Once the form is generated in your Google account, you have complete control to add, edit, or remove questions as needed.
Is this form a diagnostic tool?
The DASS-21 is a screening and symptom measurement tool, not a formal medical diagnosis. It should be used in conjunction with professional clinical evaluation.
Get this form in your Google Drive
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