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Heavily SedatedSTAND · FIGHT · ADVANCE

Private intake

Before you start

About 5 minutes. There are no wrong answers, and nothing here gets you turned away for being honest. Your coach is the only person who reads this. It helps us make sure the plan fits you, and tells us when you'd be better served by a licensed counselor too.

1. About you

It doesn't have to be your real name.

Use the same one you'll check out with. A private address is fine.

Have you served in the military?

2. Where you are

In the past month, how often have you viewed porn or acted out sexually in a way you wanted to stop?
Have you tried to cut back or stop?
How heavy is the guilt or shame you carry about it?

3. A quick health check

These help us know when licensed care should be part of your plan. Coaching can't diagnose or treat anything, but we can make sure you're not missing help you need.

Over the last 2 weeks, how often have you had little interest or pleasure in doing things?
Over the last 2 weeks, how often have you felt down, depressed, or hopeless?
In the past 2 weeks, have you had thoughts that you'd be better off dead, or of hurting yourself in some way?
How often do you use alcohol or drugs to cope, relax, or numb out?
Is there something from your past (combat, abuse, a loss, something you saw) that still hits you hard, or that you work to avoid thinking about?

You don't need to explain. A yes just tells us to talk about licensed support with you.

Are you seeing a licensed counselor or therapist right now?

4. Agreements

Your answers are sent securely to your coach. They are never sold, shared, or used for ads.

Mood questions adapted from the PHQ-2 (Kroenke, Spitzer & Williams), free for public use. This is not a diagnosis.