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Your Name
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One a scale of 1 (amazingly well) - 5 (I’m really struggling), how would you say that you are coping in general right now?
1 (Amazing)
2
3
4
5 (I'm really struggling)
If a weekly Google Meet were available for relaxation exercises (guided relaxation, breathing exercises, etc) would you be interested in attending?
Yes
Yes if it was private/individual
No
Would you like me to check in with you individually via email about some struggles you’re having?
Yes
No
Would you like to talk with me about ways you can better support a friend you’re concerned about?
Yes
No