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What would you like to talk about today?
Feeing anxious
Trouble focusing on school or work
Feeling low or down
Low motivation
Low self-confidence
Worries about the future
Feeling rushed or pressured
Shortness of breath
Romantic relationships
Family
Career/education path
Irritability
Difficulty managing anger
Hurting others
Panic symptoms
Past trauma
Loss of a loved one
Bullying
Searching for meaning in life
Personal growth
Relationship challenges
Difficulty leaving home
Trouble speaking
Difficulty reading social cues
Trouble organizing thoughts
Poor planning skills
Difficulty keeping things tidy
Trouble sleeping
Being talked about negatively
Feeling like I want to live
Thinking about suicide
Suicide attempt
Self-harm
Overeating
Purging after eating
Struggling to quit (alcohol, tobacco, drugs, gambling, etc.)
Domestic violence
Phobias
Other
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How often is this affecting your daily life right now?
Every day
Almost every day
Sometimes
Not urgent
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When was the last time you thought about suicide?
Never
Over a year ago
Within the last 3 months
Within the last month
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Do you have access to any methods or tools to harm yourself?
Yes
No
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What is your age?
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
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46
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48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70+
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What is your date of birth?
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Tell us about yourself! What is your gender?
Female
Male
Non-binary
Transgender
Agender
Not sure
Prefer not to say
Other
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What is your sexual orientation?
Heterosexual
Homosexual / Gay or Lesbian
Bisexual
Asexual
Queer
Not sure
Prefer not to say
Other
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Do you prefer a therapist with specialized knowledge for LGBTQIA+ concerns?
Yes
No
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Have you ever had therapy before?
Yes
No
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Are you currently seeing a psychiatrist or any other mental health related services?
Currently attending
Previously attended
No
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Have you discussed using this service with your current provider and obtained permission?
Yes
No
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Please tell us about your situation at the time.
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What do you expect from your therapist?
Affirm me
Empathize with me
Explore my past together
Teach coping skills
Give opinions
Correct me when I’m wrong
Assign homework
Set goals
Not sure yet
Other
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Please select topics you are interested in.
Self-understanding
Self-esteem
Personality
Communication
Relationships
Work / Career
LGBTQIA+
Sex
Anxiety
Depression
Highly Sensitive Person (HSP)
Romantic relationships
Marriage
Family / Relatives
Sexual abuse
Cultural differences / Study abroad
Trauma
Phobias
Panic
Sexual trauma
Domestic violence (DV)
Addiction
Eating disorders (Anorexia / Binge eating)
Grief and loss
Codependency
Job change
Job hunting / Career
Adaptability
Infertility
Abuse experiences
Toxic parents
Refusal to work
ADHD
Neurodivergent
Menopause
Stress
Bullying
Pregnancy / Childbirth
Parenting / Childcare
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Do you have any preferences for your therapist?
Female
Male
No preference
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How much would you like to pay for 50 minutes?
￥9000~Psychotherapist
￥3000~￥9000Therapist
￥2000~￥5000Associate Therapist
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