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All My Friends Are Dead
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Intake form
Help us serve you better
Name
*
Email address
*
What is your current state of mind?
Please select at least one option.
Anxious
Depressed
Stressed
Indifferent
Hopeful
How do you usually cope with negative thoughts?
Please select at least one option.
Talking to friends
Engaging in hobbies
Seeking professional help
Exercising
Meditating
Avoiding the issue
What specific support are you seeking?
Select
Emotional support
Guidance on coping strategies
Connection with like-minded individuals
Resources for mental health
Have you previously sought help for your mental health?
Select
Yes
No
What activities bring you joy or peace?
Which service or services are you interested in?
Please select at least one option.
Life valuation sessions
Existential workshops
Targeted Individual Coverall
Stress release techniques
Additional questions or comments
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