Building Emotional Intelligence Self Esteem - Toronto

Instruction: Please answer all of the questions in this questionnaire to the best of your ability.


Personal Information / 个人信息

Information in this section will be encrypted when stored on our server, but it is recommended that you submit this form over a private (e.g. home) network.

Psychosocial Screen / 心理與社交健康的評估表

This questionnaire provides you with a means of reporting problems that you may be having as an individual or in your relationships with your family and others whom you know or work with. It is not a test, so there are no right or wrong answers. Answer each item as carefully and as accurately as you can.


Problem checklist / 问题询问表

Please check any of the following items that are currently problems for you. If none apply, check "None of the above" at the bottom of the list.


Burns Depression Checklist / 情緒低落程度評估表

Instruction: Please indicate how much you have experienced each of the following during the past week, including today.

請選出你最近一星期裡(包括今天)所經歷的。 (譯自:David D. Burns, 1996新版)

Thoughts and Feelings / 情緒低落的思想和感覺

Activities and Personal Relationships / 活動和個人關係

Physical Symptoms / 身體的症狀

Suicidal Urges / 自殺傾向

Anyone with suicidal urges should seek help from a mental health professional immediately

Burns Anxiety Inventory / 緊張程度評估表

Category I: Anxious Feelings / 緊張的感覺

Category II: Anxious Thoughts / 緊張的思想

Category III: Physical Symptoms / 身體的症狀

Relationship Satisfaction Scale / 關係滿足評估表

Select the category that best describes the amount of satisfaction you feel in your closest relationship.

Note: Although this test assesses your marriage or most intimate relationship, you can also use it to evaluate your relationship with a friend, family member, or colleague. If you do not have any intimate relationships at this time, you can simply think of people in general when you take the test.

請選出你在最親密的關係中所感到的滿足程度。雖然這問卷是用來評估你的婚姻或最親密的關係,也可以用來評估你與朋友、家人、同學和同事之間的關係。若果你現今沒有親密的關係,可以用來評估你與其他人的關係。(譯自:David D. Burns, Ten Days to Self-Esteem, New York: William Morrow, 1993)

Index of Self-Esteem / 自我形象評估表

This questionnaire is designed to measure how you see yourself. It is not a test, so there are no right or wrong answers. Please answer each item as carefully and accurately as you can by selecting the option that describes the extent of these feelings.

這問卷是用來量度你的自尊和自我形象。這不是一個測驗,所以沒有對或錯的答案。請盡量小心,並準確和誠實地選出最適合的答案。(譯自Index of Self Esteem, The Dorsey Press, 1982)