STEP 2 - CAN YOU TELL US A LITTLE MORE?

WE REALLY WANT TO TAILOR OUR SUPPORT FOR YOUR INDIVIDUAL NEEDS. YOU CAN HELP US BY TELLING US MORE ABOUT THE FOLLOWING:

    1

    How long have you had anxiety?

    2

    How much does the anxiety take over?

    RARELYSOMETIMESOFTENMOSTLYALL OF THE TIME

    3

    How many hours in the day are you feeling anxious?


    Hours or less

    PER DAY

    4

    Have you experienced any trauma in your life?

    5

    What's the impact of the anxiety on yourself?

    6

    What's the impact of the anxiety on your family and friends?

    7

    Have you been diagnosed with depression or any other mental health condition?

    8

    Have you sought help for your anxiety before?

    YESNO

    If yes, please give details here

    9

    How much support do you think you need to manage the anxiety?

    10

    What will your life be like when you can manage the anxiety?

    11

    Do you have any underlying health conditions or diagnosed health conditions? (Please give details here)

     

    12

    About You


    13

    Your Contact Details



     

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