USC - Mental Health Assessment

1
Here, you will be asked to answer the following questions based on the mental state you are currently in.

Your information is secure and will not be shared with third parties, as we maintain a strict HIPAA compliance policy.
2
Have you been experiencing one or more of the following in the past two or three weeks?* This field is required.
A lack of desire to engage in your usual hobbies/interests
Anxiety
Depression
Suicidal thoughts
Difficulty with focus
Difficulty falling asleep or staying asleep
ADHD, OCD, bipolar, anorexia
3
Name* This field is required.
First Name
Last Name
4
Email* This field is required.
5
Phone Number* This field is required.
6
What is your preferred method of communication?* This field is required.
Email
Phone
7
If you have anything else you’d like to share with us, please do so here.
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