Free Mental Health Check from Sana Psychological.

1

In the past 3 months, have you felt less enthusiasm for life and hobbies?* This field is required.

YESNO

2

In the past 3 months have you had changes to your eating, or sleeping habits not created by a physical condition?* This field is required.

YESNO

3

In the past 3 months have you been sad, down, blue and/or numb the majority of the time or significantly more than usual?* This field is required.

YESNO

4

In the past 3 months have you had thoughts or plans of hurting yourself?* This field is required.

YESNO

5

In the past 3 months, have you had panic attacks?* This field is required.

YESNO

6

In the past 3 months have you experienced nightmares or flashbacks that are disruptive to your functioning?* This field is required.

YESNO

7

In the past 3 months, have you felt your feelings were out of control?* This field is required.

YESNO

8

In the past 3 months have you struggled with increased substance use and/or behaviours like spending, gambling or others that have caused problems for you or others?* This field is required.

YESNO

9

In the past 3 months, have you been trying to abstain or moderate a behaviour and find you can’t?* This field is required.

YESNO

10

In the past 3 months, have you had any recent major changes or stressors?* This field is required.

YESNO

11

In the past 3 months, have you not had or taken time to look after yourself?* This field is required.

YESNO

12

In the past 3 months, have you had out of the norm problems at work or in relationships?* This field is required.

YESNO

13

Do you feel your mental health has declined recently?* This field is required.

YESNO

14

What is your email? We'll send you more info.* This field is required.You may receive recommendations & free resources from Sana Psyc; you are free to unsubscribe at any time.

example@example.com

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Calculation

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Sorry :( This form is only availble in Canada

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