Shift: A Stress Management Experience Enrollment Survey (Seattle)
Shift is One Medical’s stress and anxiety management program. Over four sessions, you’ll learn proven, practical tools to help you feel calmer and more at ease in your daily life.

Please answer the following quick questions so we can get to know you.

As of April 2020, we will be offering our Shift series virtually, through the HIPAA compliant Zoom video meeting platform.
Email address *
Name (First and Last) *
Date of Birth *
MM
/
DD
/
YYYY
Are you interested in participating in a 4 week, group-based virtual program designed to improve emotional well-being and alleviate stress and anxiety? *
Please let us know which of the following dates you would like to attend: *
We ask that you commit to attending all four dates.
Over the past two weeks, how often have you been bothered by the following problems: *
Not At All
Several Days
More Than Half The Days
Nearly Everyday
Feeling nervous, anxious or on edge
Being unable to stop or control worrying
Worrying too much about different things
Having trouble relaxing
Being so restless that it is hard to sit still
Becoming easily annoyed or irritable
Feeling afraid, as if something awful might happen
If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? *
Which of the following symptoms do you experience when feeling stress or anxiety? *
Required
Rate how severe these symptoms are for you *
Do you feel your stress or anxiety is due to current life circumstances or have you experienced this as a pattern in your life?
Clear selection
You'll be asked to briefly check in with one other participant each week between sessions (by method of your choosing). Are you comfortable doing that? *
How did you hear about the workshops? *
If you have any questions about this series, or you would like to be invited to a future series, please message Ashley Brown, our program coordinator: abrown@onemedical.com
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