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Therapeutic Assessment
Name
*
Email Address
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Phone
We will really appreciate if you can kindly drop your number so that we reach you faster. Thank you for understanding
How would you like us to deliver your results? (You can choose options you are cool with)
Call
Text
Whatsapp
Email
We recommend Call (Direct/via whatsapp) so that your assigned psychotherapist can directly brief you on your results and offer personalized recommendations based on your submission. You would be sent a reminder text/email when your results are ready (usually within 60 minutes), then schedule an available time for your assigned psychotherapist call. We will not charge you for this call. Thank you very much.
General Emotional State
How often do you feel lonely or isolated?
Rarely
Occasionally
Frequently
Almost Always
How would you describe your current level of insecurity?
Low
Moderate
High
Do you often feel hopeless or without purpose?
No, I rarely feel hopeless
Occasionally, but I can usually find motivation
Often, I struggle with finding purpose
Coping Mechanisms and Emotional Resilience
When you feel emotionally low, how do you typically cope?
Talk to friends or family
Distract myself with work or hobbies
Use mindfulness techniques (meditation, deep breathing, etc.)
I don’t have any specific coping mechanisms
Do you feel that you have strong emotional support from people around you?
Yes, I have strong support
I have some support but it’s limited
No, I don’t feel supported by others
Triggers and Emotional Awareness
Are there specific situations that often trigger feelings of insecurity or loneliness?
Being alone in social situations
Comparison with others
Receiving criticism
Other
Do you find it hard to identify or understand your emotions?
No, I can usually identify my emotions
Sometimes, it’s hard for me to understand what I’m feeling
Yes, I often feel confused about my emotions
Mental and Physical Well-being
How would you rate your mental energy on a daily basis?
High, I feel mentally energized
Moderate, I can manage most days
Low, I feel mentally drained often
Do physical symptoms like fatigue, headaches, or insomnia accompany your emotional struggles?
Yes, frequently
Occasionally
Rarely
Seeking Help
Have you sought any professional help for your emotional struggles?
Yes, I currently see a therapist or counselor
No, but I’m considering it
No, I haven’t sought help
Do you feel open to exploring therapeutic practices (counseling, mindfulness, etc.) to improve your emotional well-being?
Yes, I’m open and willing
Maybe, but I have some reservations
No, I don’t think it would help
Submit
Let's Talk
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