Houcut

What is your gender identity?

Male Female Transgender Male Transgender Female Non-binary Gender-queer Two-spirit I don't know Others

kindly share your age

What is your current relationship status?

Single

Married

In a relationship

Separated

Widowed

Other

Have you ever engaged in a conversation with a psychologist or counselor previously?

Yes

No

"Please indicate if you have encountered any of the following experiences within the past two weeks:"

"Have you recently felt a lack of interest in your work, resulting in feelings of frustration?"

"Have you faced any challenges with your sleep patterns, such as difficulty falling asleep, waking up during the night, or exces- sive sleep?"

"Have you been experiencing fatigue or a noticeable lack of energy recently?"

"Have there been changes in your eating habits, such as eating less or overeating?"

"Have you struggled to focus on activities like reading a newspa- per or watching TV?"

"Do you have negative self-per- ceptions or feel you're not meeting expectations"

"A leaning toward self-hurt"

"Having overwhelming anxiety."

"Have these problems made it difficult to manage work,chores, and relationships?"

Are you presently using any medication?

Yes

No

Which language would you like to use for our conversation? Also, are you currently attending therapy sessions?

How were you introduced to Houcut?

Through a person

Discovered on Snapchat

Through a podcast

Heard about it on the radio

Found it on the internet

Noticed it on a poster or billboard

Through social media posts

Saw it in a TV advertisement

from friends or family

Other