Questions Before the Deeper Dive

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Email *

First and Last Name

Since our last call, have you noticed any specific situations or events that trigger your anxiety?

Yes

Clear selection

Do you often find yourself avoiding certain situations or activities due to anxiety?

Yes

Clear selection

Are you open to trying new methods or techniques to manage your anxiety?

Yes

Clear selection

Do you feel that anxiety impacts your physical health as well as your mental health?

Yes

Clear selection

Are you currently using any medication or therapy specifically for anxiety?

Yes

Clear selection

Are you willing to invest your time and resources into improving your situation?

Yes

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report