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Wellness Screening Form

Please read each statement and choose a number 0, 1, 2 or 3 which indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.

Rating Scale:
0 - Did not apply to me at all
1 - Applied to me to some degree
2 - Applied to me considerably
3 - Applied to me very much

Personal Data


Who is completing this DASS form?

Please select whether you're a Student or a Staff of Central University