How Are You Doing?

1

In the past 3 months, has your mental health felt poorer than usual?* This field is required.

YESNO

2

In the past 3 months have you often felt down, blue, depressed and/or numb?* This field is required.

YESNO

3

Have you found yourself turning to escape and/or distraction to cope?* This field is required.

YESNO

4

In the past 3 months have you experienced a significant transition, stressor, or physical health experience?* This field is required.

YESNO

5

Have you been diagnosed with a mental health condition already?* This field is required.

YESNO

6

In the past 3 months, have you had thoughts of suicide, hurting others, and/or have you injured yourself to help deal with emotions?* This field is required.

YESNO

7

Do you feel less in control of your thoughts, emotions, reactions, and life than usual?* This field is required.

YESNO

8

In the past 3 months have you been feeling anxious and worried about the future?* This field is required.

YESNO

9

Are you using substances, like alcohol or drugs, or behaviours like overworking, sex, food, spending, or gaming to cope?* This field is required.

YESNO

10

Do you feel that life has become unmanageable?* This field is required.

YESNO

11

Do you have big feelings but not know what to do with them?* This field is required.

YESNO

12

Do you feel that it is time for a change in your self and how you cope with life?* This field is required.

YESNO

13

Are you experiencing symptoms that are causing you concern or distress?* 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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