Empower Your Mind: Mental Health Challenges Survey

What mental health challenges are you facing?

Anxiety Depression Stress Trauma Relationship issues

How do these challenges impact your daily life?

Work performance Relationships Physical health Sleep quality Social interactions

Have you sought help for your mental health challenges before?

Yes, from a therapist Yes, from a counselor Yes, from a support group No, not yet No, I prefer self-help

What kind of mental health support are you looking for?

Therapy sessions Medication Management Group therapy Online support Self-help resources

What barriers have prevented you from seeking help?

Stigma around mental health Financial concerns Lack of time Limited access to services Fear of judgment

How important is mental health to you?

Very important Important Moderately important Slightly important Not important

All set, how can we reach you?

Name

Phone

Yes, I have read and agree to the Terms and Conditions. (Details here)

Thanks for sharing!

We will be in touch shortly.

Great, got your response!

Thank you

Thank you for sharing your mental health challenges with us!