Workplace Wellness Intake Form "*" indicates required fields Email* First Name* Last Name* On a scale of 1 to 10, how would you rate the urgency of seeking support through a wellness in the workplace session?* 1 2 3 4 5 6 7 8 9 10 What prompted you to seek support through a wellness in the workplace session?*From 1 to 10, how would you rate your current mental well-being within your workplace environment?* 1 2 3 4 5 6 7 8 9 10 How would you describe your current mental well-being in the context of your workplace?*On a scale of 1 to 10, how significantly do specific stressors or challenges at work impact your mental health?* 1 2 3 4 5 6 7 8 9 10 Are there specific stressors or challenges at work that have been impacting your mental health?*From 1 to 10, how pressing are your concerns or struggles related to mental well-being while at work?* 1 2 3 4 5 6 7 8 9 10 What are your most pressing concerns or struggles related to mental well-being while at work?*On a scale of 1 to 10, how effectively do you believe you currently cope with stress or mental health challenges in the workplace?* 1 2 3 4 5 6 7 8 9 10 How do you currently cope with stress or mental health challenges in the workplace?*From 1 to 10, how much do various aspects of your work environment contribute to feelings of anxiety, overwhelm, or dissatisfaction?* 1 2 3 4 5 6 7 8 9 10 Can you identify any aspects of your work environment that contribute to feelings of anxiety, overwhelm, or dissatisfaction?*On a scale of 1 to 10, how supported do you feel by your workplace in addressing mental health concerns?* 1 2 3 4 5 6 7 8 9 10 From 1 to 10, how beneficial do you think specific mental health resources or support services would be if offered by your workplace?* 1 2 3 4 5 6 7 8 9 10 Are there any specific mental health resources or support services you believe would be beneficial for your workplace to offer?*On a scale of 1 to 10, how successful have you found certain strategies or techniques in managing your mental health while at work in the past?* 1 2 3 4 5 6 7 8 9 10 What strategies or techniques have you found helpful in managing your mental health while at work in the past?*From 1 to 10, how confident are you that our sessions will effectively address your mental health experiences in the workplace?* 1 2 3 4 5 6 7 8 9 10 Is there anything else you would like to share about your mental health experiences in the workplace to ensure our sessions address your needs effectively?*
