I frequently feel on edge or tense, even when nothing is wrong. *

Totally Agree

Agree

Somewhat Agree

Somewhat Disagree

Disagree

Totally Disagree

My mind races with worst-case scenarios or “what ifs.” *

Totally Agree

Agree

Somewhat Disagree

Somewhat Agree

Disagree

Totally Disagree

It’s hard for me to stop thinking or “shut off my brain.” *

Totally Agree

Agree

Somewhat Agree

Somewhat Disagree

Disagree

Totally Disagree

I feel a sense of dread or nervousness without a clear reason. *

Totally Agree

Agree

Somewhat Agree

Somewhat Disagree

Disagree

Totally Disagree

I worry excessively about things I can’t control. *

Totally Agree

Agree

Somewhat Agree

Somewhat Disagree

Disagree

Totally Disagree

I struggle to fall asleep because of racing thoughts or worries. *

Totally Agree

Agree

Somewhat Agree

Somewhat Disagree

Disagree

Totally Disagree

I often avoid certain places, people, or situations because of fear or anxiety. *

Totally Agree

Agree

Somewhat Agree

Somewhat Disagree

Disagree

Totally Disagree

I feel physically restless like I can’t sit still or relax. *

Totally Agree

Agree

Somewhat Agree

Somewhat Disagree

Disagree

Totally Disagree

I’ve had physical symptoms (headaches, stomach issues, fatigue) that seem linked to stress or anxiety. *

Totally Agree

Agree

Somewhat Agree

Somewhat Disagree

Disagree

Totally Disagree

My body feels tight like I’m carrying tension in my chest, shoulders, or jaw. *

Totally Agree

Agree

Somewhat Agree

Somewhat Disagree

Disagree

Totally Disagree

I feel anxious even during moments when I’m supposed to be enjoying myself. *

Totally Agree

Agree

Somewhat Agree

Somewhat Disagree

Disagree

Totally Disagree

I’ve tried things like therapy, breathing exercises, or medication but still feel anxious often. *

Totally Agree

Agree

Somewhat Agree

Somewhat Disagree

Disagree

Totally Disagree

I avoid change or uncertainty because it makes me feel anxious. *

Totally Agree

Agree

Somewhat Agree

Somewhat Disagree

Disagree

Totally Disagree

I get overwhelmed easily, even by simple tasks. *

Totally Agree

Agree

Somewhat Agree

Somewhat Disagree

Disagree

Totally Disagree

How much is this impacting your daily life right now? *

A little

A moderate amount

A lot, it’s interfering with my work, sleep, or relationships

When it comes to feeling better, what sounds more like you? *

I’d love something natural if it actually works

I’m open to different options — just not sure what yet

I’ve mostly leaned on meds or traditional treatment in the past

Are you hoping to find a solution soon? *

Yes — I’m ready for change

Maybe — just seeing what’s out there

Not sure yet

When would it be best to have one of our mental health experts walk you through your answers on a free consultation call and explore some natural next steps that could help? *

Morning

Afternoon

Evening

I don't care too much about my mental health

Would you be open to sitting down with Dr. Bentley for an Anxiety Assessment? *

Yes, I’d like to have a professional assess me

Yes, I’d like to book that in right away

I don't care tooo much about my mental health

YOU'RE ALMOST DONE!

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Last Name

Phone *

Email *

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