Welcome to Real Solutions Counseling's On-line Self-Assessments

Before you begin taking the online survey, please take a moment to complete a short questionnaire about your personal demographics.  This information will be useful in evaluating your responses.  If you have any concerns please refer to our privacy policy or contact our center for more information.

Background Questions

Select one option in each question that comes closest to your answer. When you've completed the demographic questions, click on the "Continue" button below to view the screening questions.

What is your age?
Under 17
17 to 20
21 to 25
26 to 30
30 to 40
40 to 60
Over 60
No response

What is your gender?
Male
Female
No response

What is your marital status?
Married
Divorced/Separated
Living With Partner
Never Married
Widowed
No response

What is your ethnic/racial group?
African American
American Indian
Asian American
Caucasian
Hispanic
Other
No response

Have you ever been treated for?
Depression
Anxiety
Bi-Polar Disorder
Post-Traumatic Stress Disorder
None of the Above

Have you Ever Seriously Considered Suicide?
Yes
No
No response

Do you have any medical conditions?

If you are planning a follow-up session with a counselor at Kuna Counseling Center, please imput your initials for identification purposes. (optional)