Mental Health Screening
A brief screening to help identify areas of concern and connect patients with support
6 fieldsconversationalHealthcare
Fields included
Full name*
Short textEmail address*
EmailHow would you rate your current stress level? (1 = very low, 10 = very high)*
ScaleHow would you rate your sleep quality? (1 = very poor, 10 = excellent)*
ScaleWhat is your primary area of concern?*
Multiple choiceIs there anything else you'd like us to know before your consultation?
Long textMental Health Screening
A brief screening to help identify areas of concern and connect patients with support
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name@example.com
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Anxiety
Depression
Relationship issues
+3 moreType here...
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