You can always press Enter⏎ to continue

We're going to ask you a series of questions to understand your needs and help you get the right treatment for your panic attack or PTSD symptoms. This survey is confidential. It should take about 15 minutes to complete

HIPAA

Compliance

  • 1
    Freespira is available to adults and teens age 13 and over
    Press
    Enter
  • 2
    Freespira is available to adults and teens age 13 and over
    Press
    Enter
  • 3

    You are ineligible for Freespira treatment. Freespira is available to adults 13 and over. Please click Submit to exit the survey.

    Press
    Enter
  • 4
    Press
    Enter
  • 5
    Press
    Enter
  • 6
    Press
    Enter
  • 7
    Press
    Enter
  • 8
    Press
    Enter
  • 9
    Scroll down to select all that apply. Tap next when you're done.
    Press
    Enter
  • 10
    Press
    Enter
  • 11
    Press
    Enter
  • 12
    Press
    Enter
  • 13
    Press
    Enter
  • 14
    Press
    Enter
  • 15
    Press
    Enter
  • 16
    Press
    Enter
  • 17
    Press
    Enter
  • 18
    Press
    Enter
  • 19
    Press
    Enter
  • 20
    Press
    Enter
  • 21
    Press
    Enter
  • 22
    Press
    Enter
  • 23
    Press
    Enter
  • 24

    Your safety is our top priority. We recommend you pause this survey and ask you to call or text 988, the Suicide and Crisis Lifeline. The Lifelife offers free, private support 24/7. For other types of emergencies, call 911.

    Press
    Enter
  • 25

    If you’re ever struggling or need crisis support, you can call or text 988 for the National Crisis and Support Lifeline. The Lifeline is available 24/7.

    Press
    Enter
  • 26
    This will help us verify your coverage and out-of-pocket costs for Freespira.
    Press
    Enter
  • 27
    This will help us verify your coverage and out-of-pocket costs for Freespira.
    • Aetna
    • Blue Cross Blue Shield
    • CCHP
    • Cigna
    • Comcast
    • Franklin Young
    • Harvard Pilgrim (Point32Health)
    • Highmark
    • SHP
    • Tri-Care
    • United Healthcare
    • USFHP
    • VA
    • Other
    • I don't have insurance/I'm not planning to use my insurance
    Press
    Enter
  • 28
    This will help us verify your coverage and out-of-pocket costs for Freespira
    Press
    Enter
  • 29
    Nothing will be billed to your insurance. You won't be charged unless you consent to treatment with Freespira.
    Press
    Enter
  • 30
    Nothing will be billed to your insurance. You won't be charged unless you consent to treatment with Freespira.
    Press
    Enter
  • 31
    Press
    Enter
  • 32
    • Billboard Ad
    • Blog
    • Bus Ads
    • Case Manager
    • Clinician/Provider
    • Community Event
    • Direct Mailer
    • Email
    • Facebook Ads
    • Google Ads
    • Google Search
    • LinkedIn Ads
    • News Media
    • Newsletter
    • Other
    • Phone Call
    • SMS Message
    • Social Media
    • Webinar
    • Word of Mouth
    Press
    Enter
  • 33
    Please Select
    • Please Select
    • AL
    • AK
    • AR
    • AZ
    • CA
    • CO
    • CT
    • DC
    • DE
    • FL
    • GA
    • HI
    • ID
    • IL
    • IN
    • IA
    • KS
    • KY
    • LA
    • ME
    • MD
    • MA
    • MI
    • MN
    • MS
    • MO
    • MT
    • NE
    • NV
    • NH
    • NJ
    • NM
    • NY
    • NC
    • ND
    • OH
    • OK
    • OR
    • PA
    • RI
    • SC
    • SD
    • TN
    • TX
    • UT
    • VT
    • VA
    • WA
    • WV
    • WI
    • WY
    Press
    Enter
  • 34
    Press
    Enter
  • 35
    Press
    Enter
  • 36
    Press
    Enter
  • 37
    /
    Pick a Date
    Press
    Enter
  • 38
    We’ll do our best to use your preferred method, but may reach out another way if we can’t reach you
    Press
    Enter
  • 39
    Press
    Enter
  • 40
    How much has this bothered you in the past month?
    Press
    Enter
  • 41
    How much has this bothered you in the past month?
    Press
    Enter
  • 42
    How much has this bothered you in the past month?
    Press
    Enter
  • 43
    How much has this bothered you in the past month?
    Press
    Enter
  • 44
    How much has this bothered you in the past month?
    Press
    Enter
  • 45
    How much has this bothered you in the past month?
    Press
    Enter
  • 46
    How much has this bothered you in the past month?
    Press
    Enter
  • 47
    How much has this bothered you in the past month?
    Press
    Enter
  • 48
    How much has this bothered you in the past month?
    Press
    Enter
  • 49
    How much has this bothered you in the past month?
    Press
    Enter
  • 50
    How much has this bothered you in the past month?
    Press
    Enter
  • 51
    How much has this bothered you in the past month?
    Press
    Enter
  • 52
    How much has this bothered you in the past month?
    Press
    Enter
  • 53
    How much has this bothered you in the past month?
    Press
    Enter
  • 54
    How much has this bothered you in the past month?
    Press
    Enter
  • 55
    How much has this bothered you in the past month?
    Press
    Enter
  • 56
    How much has this bothered you in the past month?
    Press
    Enter
  • 57
    How much has this bothered you in the past month?
    Press
    Enter
  • 58
    How much has this bothered you in the past month?
    Press
    Enter
  • 59
    How much has this bothered you in the past month?
    Press
    Enter
  • 60
    Press
    Enter
  • 61
    Press
    Enter
  • 62
    Press
    Enter
  • 63
    Press
    Enter
  • 64
    Press
    Enter
  • 65
    Press
    Enter
  • 66
    Press
    Enter
  • 67
    Press
    Enter
  • 68
    Press
    Enter
  • 69
    Press
    Enter
  • 70
    Press
    Enter
  • 71
    Press
    Enter
  • 72
    Press
    Enter
  • 73
    Press
    Enter
  • 74
    Press
    Enter
  • 75
    Press
    Enter
  • 76
    Press
    Enter
  • 77
    Press
    Enter
  • 78
    Press
    Enter
  • 79
    Press
    Enter
  • 80
    Press
    Enter
  • 81
    Press
    Enter
  • 82
    Press
    Enter
  • 83
    Press
    Enter
  • 84
    Press
    Enter
  • 85
    Press
    Enter
  • 86
    Press
    Enter
  • 87
    Press
    Enter
  • 88
    Press
    Enter
  • 89
    Press
    Enter
  • 90
    Press
    Enter
  • 91
    Press
    Enter
  • 92
    Press
    Enter
  • 93
    Press
    Enter
  • 94
    Press
    Enter
  • 95
    Press
    Enter
  • 96
    Press
    Enter
  • 97
    Press
    Enter
  • 98
    Press
    Enter
  • 99
    Press
    Enter
  • 100
    Press
    Enter
  • 101
    Press
    Enter
  • 102
    Press
    Enter
  • 103
    Press
    Enter
  • 104
    Press
    Enter
  • 105
    Press
    Enter
  • 106
    Press
    Enter
  • 107
    Press
    Enter
  • 108
    Press
    Enter
  • Should be Empty:
Question Label
1 of 108See AllGo Back
close