SELF ASSESSMENT

Reach Out

Taking the first step toward understanding your emotional well-being is an act of courage, and we’re glad you’re here. This brief self-assessment is designed to help you explore how you’ve been feeling lately and identify areas where additional support may be helpful. While this quiz is not a diagnostic tool, it can offer insight into patterns, stressors, and experiences that may be impacting your mental health.

Answer each question honestly and at your own pace. When you’re finished, you’ll receive a gentle, informative overview of what your responses may indicate, along with suggestions for next steps.

Your Name

First

Last

Phone

Recently I've felt a persistent sense of sadness, hopelessness, or that things I used to enjoy just don't interest me anymore.

	Never	Sometimes	Often
Question 1:	NeverQuestion 1: Never	SometimesQuestion 1: Sometimes	OftenQuestion 1: Often

I find myself worrying excessively about future events or situations and my worry is interfering with daily tasks.

	Never	Sometimes	Often
Question 2:	NeverQuestion 2: Never	SometimesQuestion 2: Sometimes	OftenQuestion 2: Often

I'm struggling in one or more of my relationships (romantic partner, family, friends, colleagues) in ways I can't seem to resolve on my own.

	Never	Sometimes	Often
Question 3:	NeverQuestion 3: Never	SometimesQuestion 3: Sometimes	OftenQuestion 3: Often

I've experienced or witnessed something traumatic (or several things) that still affects how I think, feel, or relate to others.

	Never	Sometimes	Often
Question 4:	NeverQuestion 4: Never	SometimesQuestion 4: Sometimes	OftenQuestion 4: Often

I'm going through or have gone through a major life transition (e.g. job change, breakup/divorce, relocation, becoming a parent) and I'm finding it hard to adjust.

	Never	Sometimes	Often
Question 5:	NeverQuestion 5: Never	SometimesQuestion 5: Sometimes	OftenQuestion 5: Often

My use of alcohol, drugs, or other behaviours feels like a coping mechanism for emotional pain and it worries me.

	Never	Sometimes	Often
Question 6:	NeverQuestion 6: Never	SometimesQuestion 6: Sometimes	OftenQuestion 6: Often

I often feel stressed or overwhelmed and I'm having difficulty finding healthy ways to manage it.

	Never	Sometimes	Often
Question 7:	NeverQuestion 7: Never	SometimesQuestion 7: Sometimes	OftenQuestion 7: Often

I feel disconnected from myself, my feelings, or other people, and I'd like to feel more authentic and engaged.

	Never	Sometimes	Often
Question 8:	NeverQuestion 8: Never	SometimesQuestion 8: Sometimes	OftenQuestion 8: Often

I have identity or orientation-related matters (for example, LGBTQ concerns) that I'd like to explore with someone who understands.

	Never	Sometimes	Often
Question 9:	NeverQuestion 9: Never	SometimesQuestion 9: Sometimes	OftenQuestion 9: Often

I sense recurring patterns in my life (e.g. in relationships or self-worth) that I can't seem to change even when I want to.

	Never	Sometimes	Often
Question 10:	NeverQuestion 10: Never	SometimesQuestion 10: Sometimes	OftenQuestion 10: Often

I'm aware that old experiences (childhood, past relationships) are shaping how I respond now and I'd like to understand and change that.

	Never	Sometimes	Often
Question 11:	NeverQuestion 11: Never	SometimesQuestion 11: Sometimes	OftenQuestion 11: Often

I've lost someone or something important (grief, major change) and I'm not sure how to move forward.

	Never	Sometimes	Often
Question 12:	NeverQuestion 12: Never	SometimesQuestion 12: Sometimes	OftenQuestion 12: Often

disconnected is, in

I'd like to feel more resilient and able to trust myself in the face of challenges.

	Never	Sometimes	Often
Question 13:	NeverQuestion 13: Never	SometimesQuestion 13: Sometimes	OftenQuestion 13: Often

I'm open to talking with someone, being honest, and doing the work to change rather than expecting a quick fix.

	Never	Sometimes	Often
Question 14:	NeverQuestion 14: Never	SometimesQuestion 14: Sometimes	OftenQuestion 14: Often

I'm unsure what the next step is, whether I need therapy or what kind, and I'd like some guidance.

	Never	Sometimes	Often
Question 15:	NeverQuestion 15: Never	SometimesQuestion 15: Sometimes	OftenQuestion 15: Often