Find My Therapist Match | Q Mental Health

First name

Last name

Phone

Email

How do you Identify?

What's been weighing on you the most lately? (Select all that apply)

Which of these feel most like your day-to-day experience? (Select all that apply)

I replay conversations in my head

I second-guess myself a lot.

I feel on edge or can’t fully relax.

I change how I act depending on who I’m around.

I worry about how others perceive me.

I feel disconnected from myself.

I keep a lot in and don’t express it

Have any of these been your experience? ( Select all that apply)

Navigating coming out (or deciding if/when to)

Not feeling fully accepted by family

Feeling like I have to hide parts of myself

Pressure to “figure out” my identity

Dating or relationship challenges tied to identity

Feeling like I don’t fully belong anywhere

How long have you been dealing with this?

Recently (past few weeks)

A few months

Over a year

Most of my life

Have you tried therapy before?

Yes, and it helped

Yes, but it didn’t feel like a good fit

No, this would be my first time

What are you hoping will feel different?

What has made it hard to start therapy? (Select all that apply)

What is your gender preference for a therapist?

Where do you prefer therapy?

Online

In-Person

Mix of online and in-person

How ready are you to take the next step?

Ready Now

Soon, just exploring

Not sure yet