Help us get to know you survey
Here you will answer questions about yourself so we can get to know you a bit. We want YOU to feel as comfortable as possible. We are also trying to create a safe space for you to vent how you feel without feeling judged or neglected. We hear you and we are here for you. A Me Edition LLC - Join our "Mental health healing community groupchat on instagram : @a.me.edition.llc & visit "ameedition.com"
Name
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First Name
Last Name
Email
*
example@example.com
Are you okay?
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Yes
No
Eh..
What are you struggling with internally?
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How has life been treating you/life lately?
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Are you interested in starting your healing journey?
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Yes
No
Are you ready to start healing?
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Yes
No
What/who has made the biggest impact on your life? leading you to heal/focus on yourself, etc.
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What makes you feel better when you are sad/upset/depressed?
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Are you willing to do a self reflection and start working on yourself?
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Yes
No
Sort of
What is one of your gifted talents?
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Do you read the bible?
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Yes
No
I practice/follow my own religion
Is there anything you need to get off of your chest ?
Do you want to become a mental health advocate or join our community? (Read the beginning of the survey for more information)
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Yes
No
Are you on social media? If so, list your socials here.
*
Would you like to connect & continue this conversation with a mental health advocate? If “Yes” please leave your phone number below or for “No” put (N/A) below
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Yes
No
Phone number
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Did this survey help you?
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Yes
No
Kind of
Your feedback on this mental health survey:
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Submit
Should be Empty: