Join the Joan Marie Waitlist
First / Last name
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First Name
Last Name
Email address
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Phone number
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-
Area Code
Phone Number
How do you feel when thinking about your financial situation?
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A) I constantly worry about money and feel overwhelmed.
B) I feel hopeless about my finances and struggle to find motivation to improve.
C) I feel stressed about recent financial changes but believe I can adjust with time.
D) I feel confident and in control of my financial situation.
How does financial stress impact your daily life?
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A) I often feel restless, have trouble sleeping, or experience racing thoughts about money.
B) I feel unmotivated, fatigued, or disconnected from things I used to enjoy due to financial stress.
C) I’ve been struggling to adapt to recent financial changes, leading to emotional ups and downs.
D) Financial stress does not significantly affect my mood or daily life.
When facing financial challenges, how do you typically cope?
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A) I feel panicked or constantly worry, making it hard to focus or make decisions.
B) I feel like giving up or withdrawing from responsibilities because it all feels too difficult.
C) I feel overwhelmed at first but try to find ways to adjust, even if it takes time.
D) I take proactive steps to manage my finances without significant emotional distress.
Which Medical Insurance do you have?
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Anthem Blue Cross, Blue Shield
Buckeye Community Health Plan
Aetna
Humana
AmeriHealth
Molina
CareSource
How did you hear about us?
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Referred by a friend or family member
Google search
Social media (Instagram, Facebook, etc.)
Attended an event or workshop
Saw a flyer or brochure
Referred by a professional (therapist, doctor, etc.)
Other (please specify)
Other
If referred, who were you referred by?
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