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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
Digital Onboarding Survey
  • 1
    Freespira is available to adults and teens age 13 and over
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  • 2
    Freespira is available to adults and teens age 13 and over
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  • 3

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

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  • 9
    Scroll down to select all that apply. Tap next when you're done.
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  • 23
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  • 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.

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  • 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.

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  • 26
    This will help us verify your coverage and out-of-pocket costs for Freespira.
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  • 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
    • Highmark
    • SHP
    • Tri-Care
    • United Healthcare
    • VA
    • Other
    • I don't have insurance/I'm not planning to use my insurance
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  • 28
    This will help us verify your coverage and out-of-pocket costs for Freespira
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  • 29
    Nothing will be billed to your insurance. You won't be charged unless you consent to treatment with Freespira.
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  • 30
    Nothing will be billed to your insurance. You won't be charged unless you consent to treatment with Freespira.
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  • 31
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  • 32
    • Clinician/Provider
    • Direct Mailer
    • Email
    • Facebook Ads
    • Freespira Website
    • Google Ads
    • Google Search
    • LinkedIn Ads
    • News Media
    • Other
    • SMS Message
    • Point 32 Innovation Challenge
    • Case Manager
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  • 33
    Please Select
    • Please Select
    • AL
    • AK
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    • AZ
    • CA
    • CO
    • CT
    • DC
    • DE
    • FL
    • GA
    • HI
    • ID
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    • IN
    • IA
    • KS
    • KY
    • LA
    • ME
    • MD
    • MA
    • MI
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    • NE
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    • NC
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    • OK
    • OR
    • PA
    • PR
    • RI
    • SC
    • SD
    • TN
    • TX
    • UT
    • VT
    • VI
    • VA
    • WA
    • WV
    • WI
    • WY
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    /
    Pick a Date
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  • 40
    How much has this bothered you in the past month?
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  • 41
    How much has this bothered you in the past month?
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  • 42
    How much has this bothered you in the past month?
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  • 43
    How much has this bothered you in the past month?
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  • 44
    How much has this bothered you in the past month?
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  • 45
    How much has this bothered you in the past month?
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  • 46
    How much has this bothered you in the past month?
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    How much has this bothered you in the past month?
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  • 48
    How much has this bothered you in the past month?
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    How much has this bothered you in the past month?
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  • 50
    How much has this bothered you in the past month?
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    How much has this bothered you in the past month?
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    How much has this bothered you in the past month?
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    How much has this bothered you in the past month?
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  • 54
    How much has this bothered you in the past month?
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  • 55
    How much has this bothered you in the past month?
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  • 56
    How much has this bothered you in the past month?
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  • 57
    How much has this bothered you in the past month?
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  • 58
    How much has this bothered you in the past month?
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  • 59
    How much has this bothered you in the past month?
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