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Mental Health
Yes No Something
Else

OVERALL FEELINGS

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Feelings

happy excited loved grateful

proud hopeful surprised relief optimistic content

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Feelings

sad angry hurt disappointed

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Supported Conversation:
Mental Health
Yes No Something
Else

Physical
Feelings

tired sick cold hot

hungry thirsty uncomfortable pain itchy

Who

caregiver nurse doctor aide

therapist minister/priest spouse kids grandkids friend

pet

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Supported Conversation:
Mental Health
Yes No Something
Else

Subjects

health family work money

housing medication legal

Specific
Subjects

safe not safe abuse trauma

suicide drugs bills job loss sex relationship

disease will advance treatment alcohol


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