Form Help us match you to the right therapist What type of therapy you are looking for?Individual(for myself)Couples(for myself and my partner)Children Therapy (for my child)Adolescent/Teen TherapyGroup TherapyFamily TherapyWhat is your gender identity?MaleFemaleInsert Your AgeHow do you identifyStraightGayLesbianBI/PanPrefer not to sayWhat is your relationship status?SingleMarriedIn a relationshipDivorcedWidowOtherDo you consider yourself to be religiousYesNoWhich religion do you identify with?ChristianityJudaismIslamOtherDo you consider yourself to be spiritualYesNoHave you ever been in therapy before?YesNoWhat led you to consider therapy today?I've been feeling depressedI feel anxious or overwhelmedMy mood is interfering with my job/school performanceI struggle with building or maintaining relationshipsI can't find purpose and meaning in my lifeI am grievingI have experienced traumaI need to talk through a specific challengeI want to gain self confidenceI want to improve myself but i don't know where to startRecommended to me (friend, family, doctor)Just exploringOtherWhat are your expectations from your therapist? A therapist who....ListensExplores my pastTeaches me new skillsChallenges my beliefsAssigns me homeworkGuides me to set my goalsProactively checks in with meOtherI don't knowHow would you rate your current physical health?GoodFairPoorHow would you rate your current eating habit?GoodFairPoorAre you currently experiencing overwhelming , sadness, grief or depression?YesNoOver the past 2 weeks, how often nave you been bothered by any or the following problems: Little interest or pleasure in doing things.Not al allSeveral DaysMore than half the daysNearly every dayOver the past 2 weeks, how often have you been bothered by any of the following problems: Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual.Not at allSeveral daysMore than half the daysNearly every dayOver the past 2 weeks, how often have you been bothered by any of the following problems: Feeling down, depressed or hopeless.Not at allSeveral daysMore than half the daysNearly every dayOver the past 2 weeks, how often have you been bothered by any of the following problems: Trouble falling asleep, staying asleep, or sleeping too much.Not at allSeveral daysMore than half the daysNearly every dayOver the past 2 weeks, how often have you been bothered by any of the following problems: Feeling tired or having little energy.Not at allSeveral daysMore than half the daysNearly every dayOver the past 2 weeks, how often have you been bothered by any of the following problems: Poor appetite or overeating.Not at allSeveral daysMore than half the daysNearly every dayOver the past 2 weeks, how often have you been bothered by any of the following problems: Feeling bad about yourself or that you are a failure or have let yourself or your family down.Not at allSeveral daysMore than half the daysNearly every dayOver the past 2 weeks, how often have you been bothered by any of the following problems: Trouble concentrating on things, such as reading the newspaper or watching television.Not at allSeveral daysMore than half the daysNearly every dayOver the past 2 weeks, how often have you been bothered by any of the following problems: Thoughts that you would be better off dead or of hurting yourself in some way.Not at allSeveral daysMore than half the daysNearly every dayOver the past 2 weeks, how often have you been bothered by any of the following problems: How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?Not difficult at allSomewhat difficultVery difficultExtremely difficultAre you currently employed?NoYesDo you have any problems or worries about intimacy?YesNoHow often do you drink alcohol?NeverInfrequentlyMonthlyWeeklyDailyWhen was the last time you thought about suicide?NeverOver a year agoOver 3 months agoOver a month agoOver 2 weeks agoIn the last 2 weeksAre you currently experiencing anxiety, panic attacks or have any phobias?NoYesAre you currently taking any medication?NoYesAre you currently experiencing any chronic pain?YesNoHow would you rate your current financial status?GoodFairPoorHow would you rate your current sleeping habits?GoodFairPoorHow do you prefer to communicate with your therapist?Mostly via messagingMostly via phone or video sessionsNot sure yet (decide later)CheckboxMale therapistFemale therapistChristian-based therapyTherapist from the LGBTQ+ communityOlder therapist (45+)Non-religious therapistTherapist of colorAre there any specific preferences for your therapist?Who referred you to Finnch WellnessYouTubePodcastStreaming (Hulu, Peacock, etc)TVTiKTokMagazine or newspaperFriend or family memberSocial media postRadioCelebrityTwitchGoogle searchOtherWhich Country are you in?What is your preferred languageEnglishUrduRussianFrenchYou have successfully completed your formSend Message
