Anxiety Relief Programs
Let’s make sure we understand your needs—this questionnaire gives us both insight into your current challenges so we can tailor the program to fully support your transformation.
Your email address
*
example@example.com
How often do you experience anxiety?
Daily
A few times a week
A few times a month
Rarely
How would you rate your anxiety on a scale of 1 to 10 (1 being mild, 10 being overwhelming)?
1-3 (Mild)
4-6 (Moderate)
7-8 (Severe)
9-10 (Extreme)
How long have you been struggling with anxiety?
less than a year
1 - 2 years
3-5 years
5 - 10 years
10+ years
How does anxiety currently affect your daily life? (Select all that apply)
Negative impact on work and work relationships
Trouble sleeping
Avoiding social situations
Physical symptoms (e.g., headaches, stomach issues)
Other
Have you used any methods or techniques to manage anxiety before? (Select all that apply)
Therapy or counselling
Medication
Meditation or mindfulness practices
Physical exercise
Journaling or self-help
Other
What has been your biggest frustration or challenge with the approaches you've tried so far?
How would you rate your commitment to change on a scale from 1 to 10? (1 being low commitment, 10 being very high commitment)
1 - 3 (low commitment)
4 - 6 (moderate commitment)
7 - 8 (high commitment)
8 - 10 (very high commitment)
How would you rate your willingness to invest in yourself on a scale from 1 to 10? (1 being low willingness, 10 being very high willingness)
1 - 3 (low willingness)
4 - 6 (moderate willingness)
7 - 8 (high willingness)
8 - 10 (very high willingness)
What's the one thing you need relief from right now?
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