A short wellness check-in

This takes about three minutes, one short question at a time. It helps me understand where you’re at before our free 15-minute conversation, so we can use that time well. There are no right or wrong answers, and nothing you enter here is stored or kept anywhere — your responses stay on your device until you choose to send them to me on WhatsApp.

Your details

First or preferred name

Phone (optional)

Please enter a name and a valid email address to continue.

Over the past four weeks

I felt tired out for no good reason

Over the past four weeks

I felt nervous

Over the past four weeks

I felt so nervous that nothing could calm me down

Over the past four weeks

I felt hopeless

Over the past four weeks

I felt restless or fidgety

Over the past four weeks

I felt so restless I could not sit still

Over the past four weeks

I felt depressed

Over the past four weeks

I felt that everything was an effort

Over the past four weeks

I felt so sad that nothing could cheer me up

Over the past four weeks

I felt worthless

One more question

Over the past two weeks, how often have you been bothered by thoughts that you would be better off dead, or thoughts of hurting yourself in any way?

You’re not alone, and support is available right now

Thank you for sharing that. If you’d like to talk to someone before we meet, please reach out. These services are free and available now.

SADAG Crisis Line: 0800 567 567 (24 hours)
Cipla Mental Health Helpline: 0800 456 789 | WhatsApp 076 882 2775
Akeso Psychiatric Response: 0861 435 787 (24 hours)

Please select an answer to continue.

A little more context

Are you currently seeing, or have you previously seen, a psychologist, psychiatrist, counsellor, or other mental health professional?

Last one

Are you currently taking any medication related to your mental health, such as for mood, anxiety, or sleep?

Last step

Please tick the consent box to send your check-in.

Based on your answers

Please call one of these now

SADAG Crisis Line: 0800 567 567 (24 hours)
Cipla Mental Health Helpline: 0800 456 789 | WhatsApp 076 882 2775
Akeso Psychiatric Response: 0861 435 787 (24 hours)
Emergency: 10111 (Police) or 10177 (Ambulance)

Send this to Gideon

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