Fill out the short questionnaire to help us hit the ground running on our call ⬇️

Fill out the short questionnaire to help us

hit the ground running on our call ⬇️

What is your gender?

Man

Woman

Other

Prefer not to say

How old are you?

How old are you?

What led you to consider psychiatric care today?

(Please go beyond saying “depressed” or “anxious.” Share how these symptoms are affecting your daily functioning, mood, or overall quality of life.)

*

What are some of the things you are struggling with?

I often feel tense, on edge, or overwhelmed.

I experience excessive worry that is difficult to control.

I feel restless or keyed up, even when trying to relax.

My thoughts race or feel hard to slow down.

I have trouble concentrating because of anxiety or worry.

I feel easily irritated or frustrated.

How long have you ben experiencing these struggles?

0-3 months

3-6 months

1-2 years

2+ years

Have you been in therapy before?

Yes

No

Which state are you in?

Texas

Not in Texas and I will leave this page immediately.

You have completed the questionnaire!

Let's get you scheduled for a

15-minute consultation.

First Name *

Last Name *

Phone *

Email *

I agree to the Privacy Policy and Terms & Conditions provided by the company. By providing my phone number, I agree to receive sms messages from the business to schedule a free consultation.

NEXT

What is your gender?

Man

Woman

Other

Prefer not to say

How old are you?

How old are you?

What led you to consider psychiatric care today?

(Please go beyond saying “depressed” or “anxious.” Share how these symptoms are affecting your daily functioning, mood, or overall quality of life.)

*

What are some of the things you are struggling with?

I often feel tense, on edge, or overwhelmed.

I experience excessive worry that is difficult to control.

I feel restless or keyed up, even when trying to relax.

My thoughts race or feel hard to slow down.

I have trouble concentrating because of anxiety or worry.

I feel easily irritated or frustrated.

How long have you ben experiencing these struggles?

0-3 months

3-6 months

1-2 years

2+ years

Have you been in therapy before?

Yes

No

Which state are you in?

Texas

Not in Texas and I will leave this page immediately.

You have completed the questionnaire!

Let's get you scheduled for a

15-minute consultation.

First Name *

Last Name *

Phone *

Email *

I agree to the Privacy Policy and Terms & Conditions provided by the company. By providing my phone number, I agree to receive sms messages from the business to schedule a free consultation.

NEXT

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