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Assist us in finding the therapist that best suits your needs.
How old are you?
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What is your gender identity?
Man
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How do you identify?
Straight
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Palpitations
What is your relationship status?
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Employment Status?
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un employed
self employed
Are you religious?
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Religion ?
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Are you spiritual?
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Ever been in therapy before?
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Country
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Education
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Hobbies
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Based on your past 2 weeks, select the following issues/situations from the form below
Low Mood
Over thinking
loss of interest/pleasure in daily activities
Low Energy
Sleep Disturbance
Increased Appetite
Suicidal thoughts
Thoughts of harming others
Obbsessive Thinking
Difficulty adjusting new Places
Fear of Public Places
Fear of Social Interaction
Shortness of Breath
Anger Issues/Aggression
Feelings of being born in wrong body
Sexual Disturbances
Relationship Problems
Substance Abuse
Currently Experiencing Anxiety, Panic Attacks, have any phobeas
Next
I prefer a therapist with experience in__
Depression
Stress and anxiety
Coping with addictions
LGBTQ+ related issues
Relationship issues
Family conflicts
Trauma and abuse
Coping with grief and loss
Intimacy related issues
Eating disorders
Sleeping disorders
Parenting issues
Motivation, self esteem, and confidence
Anger management
Career difficulties
Bipolar disorder
Coping with life changes
Executive and professional coaching
Compassion fatigue
Concentration, memory and focus (ADHD)
Next
What are your expectations from your therapist? A therapist who__
Listens
Explores relationship dynamics
Teaches new communication skills
Challenges my/our beliefs
Mediate in difficult situations
Explores the impacts of families of origin
Assigns homework
Guides to set goals
Proactively checks in
Other
I don't know
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