General Quiz

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Full Name *

Email Address *

Phone

How often have you felt emotionally overwhelmed or "not yourself" lately? *

Never Occasionally More than half the days Nearly every day

How often do you feel anxious or on edge, even when there’s no clear reason? *

Never Sometimes Often Constantly

Are you finding it hard to enjoy things you used to enjoy? *

No A little Quite a bit Yes, completely

Have you had trouble falling asleep, staying asleep, or waking too early? *

No issues Occasionally Most nights Every night

How often do you feel tired or drained, even after a full night’s sleep? *

Rarely Sometimes Most days Every day

Are you experiencing difficulty concentrating or staying focused? *

Not at all Occasionally Often Very often

Do you experience racing thoughts or an inability to calm your mind? *

No Sometimes Regularly Constantly

How often do you feel irritable, agitated, or unusually impatient? *

Rarely Occasionally Often Very often

Have you been withdrawing from social situations or avoiding people? *

No A little Frequently Almost always

Do you feel overwhelmed by everyday tasks or decisions? *

Never Occasionally Most days Daily

Have you experienced any changes in appetite (eating much more or much less)? *

No changes Slight changes Noticeable change Extreme change

Are you having thoughts like “What’s the point?” or feeling hopeless? *

Never Occasionally Frequently Constantly

Do you feel physically tense, like your body won’t relax? *

Not at all Occasionally Often Always

Are you feeling emotionally numb or disconnected from your surroundings? *

Not at all Sometimes Often Constantly

Would it feel helpful just to talk to a doctor and understand what’s going on? *

No Maybe Probably Yes

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