Survey | Your Mentors

Which of the following best describes how you’re feeling right now? (Select up to 3)*

I feel stuck or lost

I’m dealing with anxiety or stress

I feel sad or low most days

I’m going through a breakup, grief, or major life change

I want to improve my confidence or self-worth

I feel unmotivated or burnt out

I just want someone to talk to and gain clarity

What are you hoping to get from a session?*

Tools or strategies to manage my emotions

Someone to listen and support me

Help making a life decision

Guidance in achieving goals

Personal growth and self-awareness

Have you seen a coach or therapist before?*

Yes, and it helped

Yes, but it didn’t help

No, this is my first time

Not sure

Do you prefer a mentor with a specific approach?*

Gentle and empathetic

Direct and practical

Inspirational and motivating

I’m not sure — I trust your recommendation

What session type are you interested in?*

One-off session

Ongoing support (weekly or biweekly)

Just exploring options for now

Do you have an NDIS plan?*

Yes, and I self-manage

Yes, and I have a plan manager

No

Would you prefer to work with:*

A female mentor

A male mentor

No preference

Name*

Phone number*

Email*

Special requests or comments*