Need Mental Health Support?
Please answer the following questions.
Sign in to Google to save your progress. Learn more
Email *
About you: *
Name *
Are you constantly on edge, feeling nervous? *
Do you feel like you can't stop worrying?
Feeling restless and having trouble relaxing? *
Do you find yourself easily irritated or annoyed? *
Do you have a feeling that something awful could happen at anytime? *
Have you experienced personal trauma? Please explain.
Are you open to joining a therapy group? *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy