Mindful Check

Mindful Check - Intake

Welcome! Please provide some basic information to personalize your assessment. Your privacy is important to us.

Email Address

Used for report routing and as your unique identifier.

Full Name

Used to personalize your report.

Age (must be 13 or older)

Gender

Female

Male

Non-binary

Prefer not to say

Profession / Primary Role

Helps provide context for workplace-related insights.

Relationship Status

Do you have children?

Yes

Prefer not to say

Current Living Situation

Who do you currently live with?

Recent Significant Loss

Have you experienced the loss of a close relationship recently?

Consent to Participate

I understand that this tool provides informational insights and is not a substitute for professional medical advice, diagnosis, or treatment.

I consent to my anonymized data (excluding email and full name after processing) being used for improving this tool and for research purposes.

I acknowledge that my responses will be processed by AI to generate a personalized report.