2. Psychiatric Illness
Are you experiencing any of the following symptoms?
Difficulty sleeping or sleeping too much
Feelings of hopelessness or worthlessness (Depression)
Lack of interest in daily activities
Feeling restless or agitated (Anxiety)
Sudden mood swings
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How long have you been experiencing these symptoms?
Less than 1 month
1–6 months
Over 6 months
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Have you been diagnosed with a mental health condition before?
Yes
No
Details
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Are you currently on medication for mental health?
Yes
No
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Is there a specific trigger or event that worsens your symptoms?
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First Name
Last Name
Email
Phone/Mobile
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