Skip to content

Therapy
Self Tests
Who We Are?
- About Us
- Contact Us
Join Us
Login
- Client
- Provider

Menu

Therapy
Self Tests
Who We Are?
- About Us
- Contact Us
Join Us
Login
- Client
- Provider

Assessment

Step 1 of 36

2%

How do you identify?

Woman

Man

Non Binary

Transfeminine

Transmasculine

Agender

I don’t know

Prefer not to say

What are your pronouns?

She/her

He/him

They/them

Other

What is your orientation (select all that apply)?

Straight

Lesbian

Gay

Questioning

Pansexual

Queer

Asexual

I don’t know

Other

How old are you?

What is your relationship status?

Single

In a relationship

Married

Domestic partnership

Separated

Divorced

Widowed

Not sure

Have you ever been in therapy before?

No

Yes

How would you rate your current physical health?

Good

Fair

Poor

How would you rate your current sleeping habits?

Good

Fair

Poor

How would you rate your current eating habits?

Good

Fair

Poor

How would you rate your current financial status?

Good

Fair

Poor

Are you currently experiencing overwhelming sadness, grief, or depression?

No

Yes

Over the past 2 weeks, how often have you been bothered by any of the following problems:

Little interest or pleasure in doing things.

Not at all

Several days

More than half the days

Nearly every day

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.

Not at all

Several days

More than half the days

Nearly every day

Feeling down, depressed or hopeless.

Not at all

Several days

More than half the days

Nearly every day

Trouble falling asleep, staying asleep, or sleeping too much.

Not at all

Several days

More than half the days

Nearly every day

Feeling tired or having little energy.

Not at all

Several days

More than half the days

Nearly every day

Poor appetite or overeating.

Not at all

Several days

More than half the days

Nearly every day

Feeling bad about yourself – or that you are a failure or have let yourself or your family down.

Not at all

Several days

More than half the days

Nearly every day

Trouble concentrating on things, such as reading the newspaper or watching television.

Not at all

Several days

More than half the days

Nearly every day

Thoughts that you would be better off dead or of hurting yourself in some way.

Not at all

Several days

More than half the days

Nearly every day

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?

Not difficult at all

Somewhat difficult

Very difficult

Extremely difficult

Are you currently experiencing anxiety, panic attacks or have any phobias?

No

Yes

Are you currently experiencing any chronic pain?

No

Yes

Are you currently employed?

No

Yes

Do you consider yourself to be religious?

No

Yes

Do you consider yourself to be spiritual?

No

Yes

Do you have any problems or worries about intimacy?

No

Yes

Are you currently taking any medication?

No

Yes

When was the last time you thought about suicide?

Never

Over a year ago

Over 3 months ago

Over a month ago

Over 2 weeks ago

In the last 2 weeks

How often do you drink alcohol?

Never

Infrequently

Monthly

Weekly

Daily

How comfortable are you with your identity?

Not at all

A little comfortable

Somewhat comfortable

Very comfortable

How much of your LGBT+ identity is contributing to your mental health concerns?

Not at all

Contributing a little bit

Somewhat contributing

Contributing a lot

Solely contributing

Do you prefer to be matched with a therapist in the LGBT community?

Yes

No

No Preference

Who referred you to Pride Counseling?

Friend or family member

Social media post

YouTube

Google search

Magazine or newspaper

Other

Which country are you in?

What is your preferred language?

Please mark all that apply

English

Afrikaans

Akan

American Sign Language

Arabic

Bengali

Croatian

Ewe

French

German

Greek

Gujarati

Haitian Creole

Hausa

Hebrew

Hindi

Igbo

Italian

Japanese

Kikuyu

Korean

Malayalam

Mandarin

Polish

Portuguese

Punjabi

Russian

Serbian

Spanish

Swahili

Swedish

Twi

Ukrainian

Urdu

Yoruba

Please mark all that apply

I’m a student

I’m a veteran

I’m disabled

I’m unemployed

I’m employed but my income is low

I’m financially impacted by the Coronavirus outbreak

Enter Your Details

Enter your nickname

Enter your email

PrideMantra

The mission of PrideMantra is to provide inexpensive, accessible, and professional online mental health care to the individuals all around the world.

Counseling

Lesbian Counseling
Gay Counseling
Bisexual Counseling
Transgender Counseling
Queer Counseling

Company

About Us
Contact Us
Join Us
Locations

Download Our App

Copyright © 2024 | PrideMantra | All Rights Reserved | Privacy Policy | Refund Policy | Terms of Use

Scroll to Top