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Assessment
Kindly fill out this form if you have ever gone through Christmas blues or know anyone who has. Be assured this will be treated with uttermost discretion and confidentiality.
* Indicates required question
Name
*
Your answer
Email
*
Your answer
What is your opinion about Christmas?
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1 point
Your answer
Do you feel pressured by the activities going on around you during Christmas?
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1 point
Yes
No
Other:
What exact activity was given you pressure?
*
Couples & Families in Pyjamas Pictures
People Dialysing their wealth and achievements on social media
The stress to cook and take care of chores
Going to show off in the village
Being Not married
Fearing missed out of all the parties going on
Other:
What kind of emotions are you currently experiencing?
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Anxiety
Loneliness
Sadness
Regret
Grieve
Disappointment
Feeling left out
Other:
Do people around you know what you are currently experiencing?
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Yes
No
Maybe
Other:
Do you know the cause of your current feelings?
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Yes
No
Other:
If yes what is it?
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Your answer
Do you feel suicidal?
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Yes
No
Sometimes
Other:
Have you ever spoken to A Professional Counsleor or Therapist before?
*
Yes
No
Other:
Give reasons for your answer above
*
Your answer
What is your general opinion about Christmas Blues?
*
Your answer
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