Why is improving your mental and physical health important to you? (Select all that apply)
For myself
For my family
Work performance
Overall quality of life
Which of the following best describes your current emotional well-being? (Select all that apply)
Persistent sadness or low mood
Loss of interest in activities I once enjoyed
Feelings of hopelessness or worthlessness
Anxiety or excessive worry
Other
Are you experiencing any of the following physical or cognitive symptoms? (Select all that apply)
Fatigue or lack of energy
Difficulty concentrating or making decisions
Sleep disturbances (too much or too little)
Changes in appetite or weight
Other
How long have you been experiencing these symptoms?
Less than a month
1–6 months
6 months to 1 year
More than 1 year
How soon are you looking to start treatment?
As soon as possible
Within the next month
Within the next 3–6 months
I’m still exploring my options
I'm interested as a...
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I'm a provider looking to invest into the device
I'm a patient looking for treatment
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