Mental Health Questionnaire

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Physique Academy Mental Health Questionnaire

In order for you to book a “Let’s Talk” call you need to complete and submit the following form. You will then be contacted by the Mental Health Team via email and invited to book a call. Keep in mind to inspect your junk mail folder, ensuring you don't miss any important messages.

Note:

This questionnaire asks about Anxiety, Depression, Trauma, Alcohol, Substance Abuse and your Mental Health. Any one (or none) of these may be affecting you. It is used, confidentially, to give some prior information to the Mental Health Team Professional who is allocated to you.

Please contact emergency services if any of the following apply to you, as you may require immediate help:

• Your life is at risk – for example you have seriously injured yourself or taken an overdose

• You are feeling suicidal and you do not feel that you can keep yourself or someone else safe

• Rapid mood swings – jumping from ecstatic to depressed and withdrawn very quickly

• Visual and auditory hallucinations – acute visions detached from reality

• Highly or easily agitated – this may include verbal threats, destruction of property or violent and out of control behaviours

• Abusive to self and others – this includes substance misuse, and self harm such as cutting

• Intense paranoia – including suspicion and distrust of people or actions without any reason

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