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1. What is your nationality?
Afghan
Albanian
Algerian
American
Andorran
Angolan
Argentine
Armenian
Australian
Austrian
Azerbaijani
Bahamian
Bahraini
Bangladeshi
Barbadian
Belarusian
Belgian
Belizean
Beninese
Bhutanese
Bolivian
Bosnian
Brazilian
British
Bruneian
Bulgarian
Burkinabe
Burmese
Burundian
Cambodian
Cameroonian
Canadian
Cape Verdean
Central African
Chadian
Chilean
Chinese
Colombian
Comoran
Congolese
Costa Rican
Croatian
Cuban
Cypriot
Czech
Danish
Djiboutian
Dominican
Dutch
East Timorese
Ecuadorean
Egyptian
Emirian
Equatorial Guinean
Eritrean
Estonian
Ethiopian
Fijian
Filipino
Finnish
French
Gabonese
Gambian
Georgian
German
Ghanaian
Greek
Grenadian
Guatemalan
Guinea-Bissauan
Guinean
Guyanese
Haitian
Herzegovinian
Honduran
Hungarian
Icelander
Indian
Indonesian
Iranian
Iraqi
Irish
Israeli
Italian
Ivorian
Jamaican
Japanese
Jordanian
Kazakhstani
Kenyan
Kittian and Nevisian
Kuwaiti
Kyrgyz
Laotian
Latvian
Lebanese
Liberian
Libyan
Liechtensteiner
Lithuanian
Luxembourger
Macedonian
Malagasy
Malawian
Malaysian
Maldivian
Malian
Maltese
Marshallese
Mauritanian
Mauritian
Mexican
Micronesian
Moldovan
Monacan
Mongolian
Moroccan
Mosotho
Motswana
Mozambican
Namibian
Nauruan
Nepalese
New Zealander
Ni-Vanuatu
Nicaraguan
Nigerian
Nigerien
North Korean
Northern Irish
Norwegian
Omani
Pakistani
Palauan
Panamanian
Papua New Guinean
Paraguayan
Peruvian
Polish
Portuguese
Qatari
Romanian
Russian
Rwandan
Saint Lucian
Salvadoran
Samoan
San Marinese
Sao Tomean
Saudi
Scottish
Senegalese
Serbian
Seychellois
Sierra Leonean
Singaporean
Slovakian
Slovenian
Solomon Islander
Somali
South African
South Korean
Spanish
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Surinamer
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Swedish
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Turkish
Tuvaluan
Ugandan
Ukrainian
Uruguayan
Uzbekistani
Venezuelan
Vietnamese
Welsh
Yemenite
Zambian
Zimbabwean
2. What is your preferred therapy language?
English
Mandarin
Hindi
Spanish
French
Arabic
Bengali
Russian
Portuguese
Indonesian
Urdu
German
Japanese
Swahili
Marathi
Telugu
Turkish
Tamil
Vietnamese
Italian
Korean
Persian
Polish
Dutch
Thai
Greek
Czech
Swedish
Hungarian
Romanian
Ukrainian
3. What is your second preferred therapy language?
English
Mandarin
Hindi
Spanish
French
Arabic
Bengali
Russian
Portuguese
Indonesian
Urdu
German
Japanese
Swahili
Marathi
Telugu
Turkish
Tamil
Vietnamese
Italian
Korean
Persian
Polish
Dutch
Thai
Greek
Czech
Swedish
Hungarian
Romanian
Ukrainian
4. What country do you live in?
Afghanistan
Albania
Algeria
Andorra
Angola
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Macedonia
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
5. What is your gender?
Male
Female
Non-binary
Transgender
Prefer not to say
6. How old are you?
6
7
8
9
10
11
12
13
14
15
16
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81
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83
84
85
86
87
88
89
90
7. How do you identify?
Straight
Gay
Lesbian
Bi or Pan
Asexual
Queer
Questioning
Prefer not to say
8. What is your relationship status?
Single
In a relationship
It’s complicated
Married
Divorced
Widowed
Other
9. How important is religion for you?
Very important
Important
Somewhat important
Not important
10. Have you ever reached out for professional support regarding your mental health?
Yes
No
Prefer not to say
11. What do you expect from your Mental Health Advisor? Someone who…
Listens well
Explores my past
Teaches new skills
Challenges my thinking
Gives homework
Helps set goals
Checks in regularly
Not sure yet
12. Would you prefer for the approach to be more structured or flexible?
Structured
Mix of both
Flexible
No preference
13. Would you prefer for the Mental Health Advisor to be more casual or formal?
Female formal advisor
Female casual advisor
Male formal advisor
Male casual advisor
Any formal advisor
Any casual advisor
Female advisor any style
Male advisor any style
14. How is your current physical health?
Good
Fair
Poor
15. How often do your mental health challenges make it hard for you to manage everyday tasks and responsibilities?
Always
Often
Sometimes
Rarely
Never
16. If you have experienced struggles, which of the following apply to you? (Check all that apply)
Anxiety (social, generalized, panic attacks, etc.)
Depression
Mood swings
Stress & burnout
Trauma or PTSD
Self-esteem or confidence issues
ADHD, OCD, or other neurodivergent traits
Other
17. Have you ever been diagnosed with a mental health condition?
Yes
No
Prefer not to say
18. What would you like to do when you are struggling with mental health?
Talking to someone and expressing feelings
Being given solutions and advice
Doing activities that distract me
Journaling or writing my thoughts
19. Do you feel comfortable being vulnerable in a conversation?
Yes, I can share easily.
I need time to open up.
I struggle to express my emotions.
20. Are you currently taking any medication for your mental health?
Yes
No
Prefer not to say
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