Survey | Clear Path Online Therapy

How often have you felt anxious or on edge recently?

Autosaves

How would you rate your recent sleep quality?

Autosaves

Where are you located?

Autosaves

Preferred language for sessions

Autosaves

Do you have a therapist gender preference?

Autosaves

Date of birth

Autosaves

Have you attended therapy before?

YesNo

Autosaves

Are you currently experiencing thoughts of self-harm or harm to others?

NoYes

Autosaves

What is your main goal for therapy?

1–2 sentences is fine.

Autosaves

Tell us about your goals