Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.How often do you feel satisfied or content with your life? *RarelySometimesOftenAlmost AlwaysIn the past two weeks, how frequently have you felt sadness, hopelessness, or emptiness? *RarelySometimesOftenAlmost AlwaysHow easy is it for you to find motivation to pursue personal goals or daily tasks? *Very DifficultSomewhat DifficultSomewhat EasyVery EasyDo you feel a sense of direction or purpose in your life? *Not at allA littleSomewhatVery Much SoWhen faced with stress, how often do you feel overwhelmed or unable to cope? *RarelySometimesOftenAlmost AlwaysHow often do you find yourself deliberately avoiding certain situations, places, or people due to distress or discomfort? *Not at allOccasionallyOftenVery FrequentlyIn the past two weeks, have you noticed any changes in your sleep patterns, such as difficulty falling asleep, frequent waking, or sleeping excessively? *Not at allOccasionallyOftenAlmost Every DayIn the past two weeks, have you experienced changes in your appetite, such as eating significantly more or less than usual?Not at allOccasionallyOftenAlmost Every DayDo you often feel disconnected or distant from others, even in social situations? *RarelyOccasionallyOftenVery OftenWhen you experience challenges, do you feel comfortable reaching out to others for support? *AlwaysSometimesRarelyNeverDo you feel you have a reliable support network of friends, family, or others who understand and support you? *Strongly AgreeAgreeNeutralDisagreeStrongly DisagreeHow would you rate your self-esteem or confidence in yourself? *Very LowSomewhat LowSomewhat HighVery HighHow frequently do you experience thoughts of self-doubt or self-criticism? *RarelyOccasionallyOftenVery FrequentlyHave you experienced events or challenges in the past that continue to affect your emotional well-being today? *RarelyOccasionallyOftenVery FrequentlyHow often do memories of difficult or traumatic experiences come up in a way that affects your current mood or mindset? *RarelyOccasionallyOftenVery FrequentlyHow clearly do you envision the future you want, including personal, career, and relationship goals? *Very ClearlySomewhat ClearlyUncertainNot at allAre there specific areas in your life where you feel "stuck" or unable to make progress? *No, not reallyOccasionallyOftenAlmost ConstantlyHow do you typically cope with stress or overwhelming emotions? (Select all that apply)Avoiding the issueTalking to othersPhysical exercise/relaxation techniques (e.g., yoga, meditation)Engaging in hobbiesSubstance useOverworking/staying busyPlaying online gamesWatching moviesSleeping more than usualEating more or less than usualHow often do you find yourself using substances (alcohol, drugs, etc.) or engaging in certain behaviors (e.g., shopping, gambling, overeating) to cope with stress or difficult emotions? *NeverOccasionallyFrequentlyAlmost AlwaysWhen experiencing emotional distress (e.g., sadness, anxiety, anger), how often do you feel like you lose control or feel overwhelmed by your emotions? *RarelySometimesOftenAlmost alwaysHow would you rate your effectiveness in completing tasks and meeting goals at work? *Very EffectiveEffectiveSomewhat EffectiveIneffectiveVery IneffectiveHow often do you feel focused and productive during your workday? *Almost AlwaysOftenSometimesRarelyAlmost Never for have work? How can we support you on your journey? *Have you tried any methods to address these challenges? What has worked, and what hasn’t? *Name *FirstLastEmail *Submit Please leave this field empty Discover tools for your transformation Subscribe now for insights to help you grow, thrive, and navigate life’s joys & challenges. We don’t spam! Read our privacy policy for more info. Check your inbox or spam folder to confirm your subscription.
