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Music 4 Life® Self-Assessment

Part A: Check any conditions you experience currently.








Part B: Identify your current experience of each emotion using the following key.

1 - Almost never 2 - Sometimes 3 - Often 4 - Most always

"U" - Unsettled Emotions :

Anxiety/fear:
1 2 3 4
Anger/hate:
1 2 3 4
Depression:
1 2 3 4
Grief/Sadness:
1 2 3 4

"S" - Soothed Emotions :

Peaceful:
1 2 3 4
Content:
1 2 3 4
Relaxed:
1 2 3 4
Tranquil:
1 2 3 4

"E" - Energized Emotions :

Playful:
1 2 3 4
Happy:
1 2 3 4
Enthusiastic:
1 2 3 4
Optimistic:
1 2 3 4

Note: If you are already working with a mental health professional, it is recommended that you consult with s/he about your self-assessment results to determine the best course of action, or contact a Music 4 Life Practitioner on MusicTelemedicine.com who will be given your permission to access your self-assessment results.

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