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Let's Focus On You!
Thank you for your interest in our Mental Health Day at The Smash Room. Here are few questions as an ice breaker to help us customize the session for you. Will take less than 5 minutes to fill.
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Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Age
*
Your answer
Phone Number
*
Your answer
What is the first thing that comes in your mind when you hear the word mindfulness?
Your answer
On the rage of 0 to 10 how do you rate your mental health
1
2
3
4
5
6
7
8
9
10
Clear selection
Do you worry about the future?
Yes
No
Sometimes
Clear selection
Do you consider yourself a workaholic?
Yes
No
Maybe
Clear selection
During the past 4 weeks, have you had any problems with your work or daily life due to your mental health?
Yes
No
Not sure
Clear selection
When was the last time you felt good about yourself?
Few days ago
Few weeks ago
Few months ago
Few years ago
I don't remember
Clear selection
How would others describe your personality? in 1 word
Your answer
Have you been through a major change in life recently? ( Job - relationship - recovery..etc )
Yes
No
Clear selection
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