Wellbeing assessment · Healing the Healers

Confidentiality & consent

Your participation is voluntary. Responses are handled confidentially and used for wellbeing support planning. The designated team may get in touch with you after reviewing your answers.

I understand the above information and agree to participate

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Part I — About you

Age group

<25 25–34 35–44 45–54 55+

Gender

Male Female Other

Professional discipline

Medicine Surgeon Psychologist Nursing Physiotherapy Allied Health Dentistry Pharmacy Other

If other, please specify

Highest qualification

MBBS FCPS MRCP/FRCP Postgraduate Diploma/Masters MPhil/MS PhD/Doctorate Other

If other, please specify

Years of professional experience

<1 1–5 6–10 11–20 >20

Current work status/designation

Student Intern/House Officer Medical/Clinical Officer Registrar/Resident Assistant Professor Associate Professor Professor Administrator Other

If other, please specify

Work setting

Government hospital Private hospital Private clinic Own clinic University/Academic institution Other

If other, please specify

Average working hours per week

<20 20–39 40–49 50–59 60+

Night/extended duties

Never Occasionally Monthly Weekly Several times per week

Part II — Open-ended reflection

What is the source of your stressful life? How has work-related stress affected your personal, family, or social life? What helps you cope when you feel overwhelmed? What specific changes in your workplace would provide the greatest relief to your wellbeing?

How would you rate your overall wellbeing at present?

How confident are you that you can manage your current responsibilities in different roles of life?

Individual scores are not a diagnosis. If you are in immediate danger, please seek emergency help.

How can we reach you?

This is kept confidential and only used by our team to arrange a private follow-up with you.

Name Email Phone City / District (optional)