BetterHelp
Help Jan Horner get to know you better
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What is your gender identity?
How do you identify?
Would you like to be matched with a therapist who specializes in LGBTQ+ issues?
What are your pronouns?
What is your relationship status?
Do you consider yourself to be religious?
Which religion do you identify with?
Would you like to be matched with a therapist who provides Christian-based therapy?
Do you consider yourself to be spiritual?
Have you ever been in therapy before?
What has kept you from seeking out or trying therapy?
Why did you stop therapy previously?
What led you to consider therapy today?
What are your expectations from your therapist? A therapist who…
Do you feel that your mental health is being impacted by the coronavirus outbreak?
How would you rate your current physical health?
How would you rate your current eating habits?
Are you currently experiencing overwhelming sadness, grief, or depression?
Over the past 2 weeks, how often have you been bothered by any of the following problems:Little interest or pleasure in doing things.
Over 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.
Over the past 2 weeks, how often have you been bothered by any of the following problems:Feeling down, depressed or hopeless.
Over 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.
Over the past 2 weeks, how often have you been bothered by any of the following problems:Feeling tired or having little energy.
Over the past 2 weeks, how often have you been bothered by any of the following problems:Poor appetite or overeating.
Over 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.
Over 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.
Over 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.
Over 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?
Are you currently employed?
Do you have any problems or worries about intimacy?
How often do you drink alcohol?
When was the last time you thought about suicide?
Have you made specific plans for suicide?
Are you currently experiencing anxiety, panic attacks or have any phobias?
Are you currently taking any medication?
Are you currently experiencing any chronic pain?
How would you rate your current financial status?
How would you rate your current sleeping habits?
Which of the following resources would be useful for you?
How comfortable are you with your identity?
How much of your LGBTQ+ identity is contributing to your mental health concerns?
Do you prefer to be matched with a therapist who is part of the LGBTQ+ community themself?
If you identify as a Christian, which denomination best describes you?
In order to give your therapist the right expectations, please answer a few questions about your spiritual background. How long has your faith been important to you?
Which best describes your prayer life?
Which best describes the nature of the therapy you are seeking?
What are your preferences around the spiritual component of your therapy (check all that apply):
How do you prefer to communicate with your therapist?
Are there any specific preferences for your therapist?
Who referred you to BetterHelp?
Please mark all that apply