Get matched to the best therapists available for you!

Please fill out this short questionnaire to provide some general and anonymous background about you.

What is your gender?

Male

Female

Non-binary

How old are you?

What is your relationship status?

Single

In a relationship

Married

Domestic partnership

Separated

Divorced

Widowed

Not sure

Have you ever been in counseling or therapy before?

Yes

How would you rate your current physical health?

Good

Fair

Poor

How would you rate your current sleeping habits?

Good

Fair

Poor

How would you rate your current eating habits?

Good

Fair

Poor

How would you rate your current financial status?

Good

Fair

Poor

Are you currently experiencing overwhelming sadness, grief, or depression?

Yes

Are you currently experiencing anxiety, panic attacks or have any phobias?

Yes

Are you currently experiencing any chronic pain?

Yes

Are you currently employed?

Yes

Do you consider yourself to be spiritual or religious?

Yes

Do you have any problems or worries about intimacy?

Yes

What is your orientation?

Straight

Gay

Lesbian

Bisexual

Not sure

Are you currently taking any medication?

Yes

Are you currently suicidal?

Yes

How often do you drink alcohol?

Never

Infrequently

Monthly

Weekly

Daily

Which country are you in?

Which state are you in?

Get matched to the best therapists available for you!

Your session is about to expire!