Template: Medical IntakeMental Health and Stress Level Assessment Form Form TemplateUse This Template Evaluate the mental health and stress levels of employees for workplace support and well-being.This is a preview of the template. Click here to use it.Full Name *Date of Birth *Position/Job Title Date of Assessment *In the past month, how often have you felt stressed at work? *NeverRarelySometimesOftenAlwaysHow would you rate your overall mental health? *ExcellentGoodAveragePoorVery PoorDo you have any current mental health conditions? YesNoPrefer not to sayIf yes, please describe Do you feel that work-related stress affects your daily life? *Not at allA littleModeratelyQuite a bitExtremelyWhat strategies do you use to manage stress? Are there any workplace accommodations or support systems that could help manage your stress levels? Would you be interested in talking to a mental health professional? *YesNoMaybeAdditional comments or concerns Signature of Employee *Sign HereDate of Submission *Use This Template