• Adult Wellness Resource & Safety Screening Form

    Confirm you’re 18+ and choose the safest next step before sharing any wellness preferences.

  • Eligibility and Location

  • Are you 18 years old or older?*

  • Wellness Topics and Impact

  • Wellness topics*
  • How much is this affecting you?*

  • Resource Preferences

  • Resource preferences*
  • Should Christian encouragement be included?*

  • Consent and Notices

  • Consent acknowledgments*

  • Privacy Notice

  • Terms of Use

  • Consumer Health Data Notice

  • Request Data Access or Deletion

  • Withdraw consent

  • Should be Empty: