quiz | Watershed Counselling

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What type of therapy are you looking for?*

Individual

Couples

Teenager/Youth

Family/Mentoring

Sex Therapy

NDIS

What is your gender?*

Male

Female

Transgender

Non-binary/Non-conforming

Other

Select your age.

How do you identify?*

Straight

Gay

Lesbian

Bi/Pan

Prefer not to say.

What is your relationship status?*

Single

In a relationship

Married

Divorced

Widowed

Other

Do you consider yourself religious?*

Yes

Which religion do you identify with?*

Christianity

Judaism

Islam

Other

Do you consider yourself spiritual?*

Yes

Have you ever been in therapy before?*

Yes

Why did you decide to consider therapy today?*

Feeling depressed lately..

There is a feeling of anxiety or overwhelm in me

The mood I'm in is interfering with my job/school performance

Relationship building and maintenance are difficult for me

My life lacks meaning and purpose..

I am grieving.

I have experienced trauma.

I need to talk through a specific challenge.

I want to gain self-confidence.

I want to improve myself but I don’t know where to start

I need guidance with my decision

Recommended to me

Just exploring

Other

How did you find about us?*

Google Search

APA Directory

IARPP Directory

ASSERT Directory

My GP

Friends and Family

Other(please submit your GP details after booking)

Can you tell me what you expect from your therapist? A therapist who…*

Listens

Explores my past.

Teaches me new skills.

Challenges my beliefs.

Assigns me homework.

Guides me to set goals.

Proactively checks in with me.

Other

In terms of your physical health, how would you rate it?*

Good

Fair

Poor

How would you rate your current eating habits?*

Good

Fair

Poor

Do you feel overwhelmed with sadness, grief, or depression at the moment?*

Yes

How often have you been bothered by any of the following during the past two weeks: There is little interest or pleasure in doing things.*

Not at all

Over several days

More than half the days

Almost every day

How often have you been bothered by any of the following during the past two weeks: Are you moving or speaking so slowly that other people may have noticed? Or the opposite-moving around a lot more than usual because you are restless or fidgety.*

Not at all

Over several days

More than half the days

Almost every day

How often have you been bothered by any of the following during the past two weeks: Having a feeling of hopelessness or depression*

Not at all

Over several days

More than half the days

Almost every day

How often have you been bothered by any of the following during the past two weeks: Not being able to fall asleep, staying asleep, or sleeping too much.*

Not at all

Over several days

More than half the days

Almost every day

How often have you been bothered by any of the following during the past two weeks: Having little energy or feeling tired*

Not at all

Over several days

More than half the days

Almost every day

How often have you been bothered by any of the following during the past two weeks: Overeating or poor appetite*

Not at all

Over several days

More than half the days

Almost every day

How often have you been bothered by any of the following during the past two weeks: Feeling unsatisfied with yourself, or feeling like you have let yourself and your family.*

Not at all

Over several days

More than half the days

Almost every day

How often have you been bothered by any of the following during the past two weeks: Concentration problems, such as watching TV or reading the newspaper?*

Not at all

Over several days

More than half the days

Almost every day

How often have you been bothered by any of the following during the past two weeks: The idea that you would be better off dead or hurting yourself.*

Not at all

Over several days

More than half the days

Almost every day

How often have you been bothered by any of the following during the past two weeks: How difficult is it for you to work, take care of things at home, or get along with others because of these problems?*

Not difficult at all

Somewhat difficult

Very difficult

Extremely difficult

Are currently employed?*

Yes

Is intimacy a problem or concern for you?*

Yes

What is your frequency of alcohol consumption?*

Never

Infrequently

Monthly

Weekly

Daily

When was the last time you considered suicide?*

Never

Over a year ago

Over 3 months ago

Over a month ago

Over 2 weeks ago

In the last 2 weeks

Can you tell me if you are currently suffering from anxiety, panic attacks, or phobias?*

Yes

Do you currently take any medications?*

Yes

Do you currently experience chronic pain?*

Yes

In what way would you rate your current financial situation?*

Good

Fair

Poor

In what way would you rate your current sleeping habits?*

Good

Fair

Poor

If you were in therapy, how would you like to experience it?*

Online (Zoom)

Online/Call/SMS (Monthly Plan)

Face to face

Not sure

Your Introduction

After submitting your personal details you will be directed to our booking calendar!

Your Name*

Your Partner's Name*

Please provide your partner details if Couple Counselling is the therapy you are looking for.

Your Email*

Your Partner's Email*

Please provide your partner details if Couple Counselling is the therapy you are looking for.

Your Phone*

✓ Valid number ✕ Invalid number

Your Partner's Phone*

✓ Valid number ✕ Invalid number

Please provide your partner details if Couple Counselling is the therapy you are looking for.

✓ Valid number ✕ Invalid number

Help us understand your needs and how we can help!

After you successfully submit the quiz, you'll gain exclusive access to our online booking system. It's a quick and easy way to secure your preferred time slot for our services.

Your Introduction