Pre Swellness Session Check-in

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Name: *

Age:

Gender:

Ethnicity:

Email address:

On a scale of 1-10, while at work this week, how would you rate your level of burnout (when at its worst)?

I’m fine/loving the job/thriving

I’m experiencing extreme stress, personal life is suffering, considering quitting on a daily basis

Clear selection

On a scale of 1 to 10, while at work this week, how would you rate your level of compassion fatigue (when at its worst)?

I’m able to be empathetic, I care for all my clients, I can be present with little effort

I am finding it very hard to be empathetic toward clients, I sometimes feel resentment for clients, I am consistently unable to be present

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report