General Questionnaire

Help us connect you with the appropriate expert

Are you Male or Female?

What is your Age?

Do you live in the United States or Canada?

Are you interested in Individual or Couples therapy?

Do you consider yourself Religious?

What is your current Relationship Status?

Have you had Counseling before?

How would you rate your current Physical Health?

How would you rate your current Mental Health?

How would you rate your current Sleeping Habits?

How would you rate your current Eating Habits?

How would you rate your current Relationships?

How would you rate your current Financial status?

Are you experiencing Panic Attacks, Anxiety, or do you break-down Crying?

Do you find it difficult to Cope or feel Overwhelmed by Sadness, Grief or Depression?

Do you find it difficult to maintain Focus, stay Organized or Prioritize your day?

Do you have low Energy and little interest in activities?

Are you in Pain?

Are you currently taking prescription Medication?

How often do you consume Alcohol?

Do you ever abuse Substances?

Do you have poor Self-esteem or continually feel like a Failure?

Do you have trouble Concentrating, setting Priorities, or completing Tasks?

Are you having Trouble at Home or Work?

What Day would you prefer to have your first session?

What time would you prefer to speak with someone?

How did you hear about TeleCounsel Group?

Thank you for completing our questionnaire.

Next is our General Information section. To ensure a high level of confidentiality, many of the upcoming questions are optional. Please complete as much as possible where comfortable.
What is TeleHealth?

Today's use of telecommunications and the internet to connect people is referred to as TeleHealth technology and its use is significantly increasing in hospitals, educational institutions and smart business everyday.
Efficient - easy appointment scheduling almost anytime - all day Convenient - counseling comes to you - no need to drive anywhere or fear missing appointments Private - no waiting rooms, no stigmas Inexpensive - a fraction of the cost of similar in-person therapy