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DASS Form Template

Assess and Understand Mental Health with Ease

If you're looking to assess mental health symptoms effectively, the DASS form template is an invaluable tool. It helps healthcare providers and therapists screen for depression, anxiety, and stress, allowing for early intervention and support. Customize your assessments, track patient progress over time, and ensure all your forms meet WCAG standards for accessibility. You can easily integrate this user-friendly template into your workflow-explore the live template now!

Use this Template (FREE) Live Preview
Full name (optional)
Email (optional)
Age
Under 18
18-24
25-34
35-44
45-54
55-64
65+
Prefer not to say
Gender
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Date
Are you completing this form for yourself?
Yes
No
I understand this self-report tool is for information only and is not a diagnosis.
Yes
No
I agree that my responses may be used to guide next steps or discussed with a qualified professional.
Yes
No
I found it hard to wind down.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I was aware of dryness of my mouth.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I couldn't seem to experience any positive feeling at all.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I experienced breathing difficulty (e.g., excessively rapid breathing, breathlessness without physical exertion).
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I found it difficult to work up the initiative to do things.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I tended to over-react to situations.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I experienced trembling (e.g., in the hands).
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I felt that I was using a lot of nervous energy.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I was worried about situations in which I might panic and make a fool of myself.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I felt that I had nothing to look forward to.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I found myself getting agitated.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I found it difficult to relax.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I felt down-hearted and blue.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I was intolerant of anything that kept me from getting on with what I was doing.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I felt I was close to panic.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I was unable to become enthusiastic about anything.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I felt I wasn't worth much as a person.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I felt that I was rather touchy.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I was aware of the action of my heart without physical exertion (e.g., sense of heart rate increase, heart missing a beat).
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I felt scared without any good reason.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
I felt that life was meaningless.
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of the time
3 Applied to me very much, or most of the time
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Paper art illustration representing a DASS form template for FormCreatorAI article.

When to use this form

Use this template when you need a quick, validated snapshot of depression, anxiety, and stress over the past week. It suits clinicians, school counselors, EAP teams, and researchers running baseline or follow-up checks. Examples include intake screening, triaging a waitlist, or monitoring progress between sessions. Pair it with the Saringan minda sihat (DASS-21) form for a brief version, or broaden screening with the DSM-5 Level 1 cross-cutting symptom measure assessment form to spot comorbid concerns. If mood elevation is suspected, add the Young mania rating scale (YMRS) form to support differential assessment. Results help you prioritize care, document severity bands, and trigger stepped interventions.

Must Ask DASS Questions

  1. Over the past week, how often did you feel down, sad, or lose interest in activities you usually enjoy?

    It captures core low mood and anhedonia, which drives the depression score and treatment plan. Clear baseline wording improves recall and makes change over time easy to see.

  2. Over the past week, how often did you feel tense, wound up, or unable to relax?

    This targets persistent tension and irritability common in high stress. Consistent phrasing yields comparable scores across check-ins.

  3. Over the past week, how often did you feel nervous, on edge, or had sudden fear or panic?

    These symptoms reflect autonomic arousal linked to anxiety severity. Clear frequency anchors help you flag who may benefit from exposure, breathing, or skills training.

  4. How much have these feelings interfered with your work, study, or daily routines?

    Function tells you how urgent support is, beyond symptom counts. It also guides accommodations and helps justify stepped care.

  5. In the past week, did you have thoughts of self-harm or that life is not worth living?

    Safety checks ensure risk is not missed when scores are high. A Yes should prompt a same-day review using the Psychiatrist interview form.

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