Mental Health and Well-being Survey

Question Title

* 1. Have you tried anxiety or depression treatment before?

Yes

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* 2. In the past two weeks, how often have you felt tired or had little energy?

Nearly every day

More than half the days

Several days

Not at all

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* 3. In the past two weeks, how often have you had trouble falling asleep, staying asleep, or sleeping too much?

Nearly every day

More than half the days

Several days

Not at all

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* 4. In the past two weeks, how often have you felt down, depressed, or hopeless?

Nearly every day

More than half the days

Several days

Not at all

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* 5. In the past two weeks, how often have you had little interest or pleasure in doing things?

Nearly every day

More than half the days

Several days

Not at all

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* 6. How have you been feeling lately? (Select all that apply)

Anxious or panicky

Relationship struggles

Trouble sleeping

Depression

Work/school stress

Addiction struggles

Other: [Text Box]

Question Title

* 7. What type of therapy are you looking for?

I need help now or very soon

Ongoing therapy the fits my schedule

I want lasting freedom from substance use

I'm interested in group therapy

Mental Health and Well-being Survey

Question Title

* 1. Have you tried anxiety or depression treatment before?

Question Title

* 2. In the past two weeks, how often have you felt tired or had little energy?

Question Title

* 3. In the past two weeks, how often have you had trouble falling asleep, staying asleep, or sleeping too much?

Question Title

* 4. In the past two weeks, how often have you felt down, depressed, or hopeless?

Question Title

* 5. In the past two weeks, how often have you had little interest or pleasure in doing things?

Question Title

* 6. How have you been feeling lately? (Select all that apply)

Question Title

* 7. What type of therapy are you looking for?

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* 8. Is there anything else you would like to share about your mental health?