Teenager Youth Quiz | Watershed Counselling

Step 1 of 14

What type of therapy are you looking for?*

Youth (18 to 25 years old)

Teenager

What is your teenager/youth gender?*

Male

Female

Transgender

Non-binary/Non-conforming

Other

Select age.*

In the past two weeks, How often has your teenager/youth expressed feeling or seemed, anxious, nervous, panicky or/and excessively worried?*

Never

Rarely

Sometimes

Frequently

Constantly/ Almost Constantly!

Has your teenager/youth talked about not wanting to live or attempted suicide?*

Yes, Has attempted suicide

Yes, Has talked about suicide(but not attempted)

Yes, Has talked about not wanting to live but has not talked about suicide

No, Has never talked about not wanting to live or suicide

In the past month has your teenager/youth hurt her/him self on purpose?*

Yes, Frequently

Yes, A few times

No, But he/she has hurt him/her self on purpose in the past

No, Has never hurt him/her self on purpose

Other

In the past 6 months, Has your teenager/youth had previous psychiatric/mental health treatment?

Yes, psychiatric hospitalization.

Yes, residential, partial hospitalization, or intensive outpatient treatment.

Yes, therapy.

No, no recent treatment

No, has never received treatment

Is your teenager/youth regularly sleeping more than 10 hours a night or less than 6 hours? **

Yes, sleeping more than 10 hours

Yes, sleeping more than 6 hours

No, but has other sleeping problems

No, sleep patterns are pretty typical for their age

Is your teenager/youth taking adequate care of their hygiene (showering at least 3 times per week, brushing their teeth twice a day, wearing clean clothes, etc.)?**

Yes

Does your teenager/youth struggle to make friends or connect with peers?**

Yes

Is your teenager/youth experiencing or displaying struggles related to gender identity or sexual orientation?**

Yes

11. Has your teenager/youth experienced or exhibited any of the following in the last 6 months? Check all that apply.*

Damaging property/vandalism

Legal issues/trouble with the law

Lying

Stealing

Running away

Physical aggression toward others

Physical aggression toward animals

Verbal aggression toward others

Defiance

Mood swings

Isolating from others

Being bullied

Bullying others

Impulsivity

Unpredictability

Recent stressors (for example: moving, a loved one's death, divorce)

Individualized education program (iep) at school

Loss of interest or pleasure

Unusually low energy

Unusually high energy

Regularly eating too much or too little

NONE

Please select one option. If there are more please mention about it in the email form.

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

Daily(monthly plan)

Weekly(monthly plan)

Fortnightly

Monthly

Other

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

Online(Zoom)

Monthly Plan(Zoom+Phone+SMS)

Face to Face

Not sure

Other

Your Introduction

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

Your Name*

Your Email*

Your Phone*

✓ Valid number ✕ Invalid number

Help us understand your needs and how we can help!

Please fill out this short quiz to give us some contextual information about your teenager/young adult.

Your Introduction