Kindly put your name here.

If you don't want to put your name, that's fine :)
This ensures that all necessary information will remain confidential.



Select your age

How do you feel right now?

What happened before you felt this way? Can you identify what happened?

What were you expecting during that time? (e.g I was expecting to be heard, I just want to talk to somebody, I want somebody to understand me etc.)

What was your mood at that time?

Do you feel vulnerable?

If not, were you afraid that nobody might understand what you are going through? Why?

Do you want to talk to somebody? *

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