Terms and Conditions *
Parent First Name
*
Email
Child First Name Initial
Child Gender
Female
Male
Gender Diverse
Prefer not to say
Child Age
4
5
6
7
8
9
10
11
12
13
14
15
16
Child's Ethnicity
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Multiethnic
Prefer not to say
City and State
Parent's Highest Academic Level
Some High School
High School or equivalent (GED)
Technical or Occupational Certificate
Associate Degree
Bachelor's Degree
Master's Degree
Doctorate
Prefer not to say
1. I was very concerned when I first learned/realized my child struggles with anxiety.
2. How did you realize anxiety was a problem for your child?
3. When I learned my child had anxiety, I had clear next steps how to help my child.
If you "Agree" or "Strongly Agree", next steps did you take?
4. How old was your child when you first realized anxiety was an issue?
4
5
6
7
8
9
10
11
12
13
14
15
16
5. Were you able to get the support you needed?
If "Yes" or "Somewhat", what helped or who did you speak with?
6. What are your current needs? (Check all that apply)
If "Other" please explain.
7. What type of support would you most want?
8. How would you and your child like to receive the information you need? (Check all that apply)
If "Other" please explain.
9. Who has diagnosed your child with anxiety? (Check all that apply)
If "Other", by whom?
10. If your child's anxiety was diagnosed by a doctor or therapist, what has your child been diagnosed with? (Check all that apply)
If "Other" please explain.
11. It has been very easy addressing anxiety in my child.
12. My child's anxiety is totally under control.
13. How long has your child been struggling with anxiety?
14. How frequently does your child struggle with anxiety?
15. What strategies are you currently using (or planning to use) to address your child's anxiety? (Check all that apply)
If "Other" please explain.
16. What are your top 3 resources?
17. Are there websites, online programs or apps you used? Please describe what did you liked or disliked and why.
18. If your child is not seeing a psychologist or therapist, why not? (Check all that apply)
If "Other" please explain.
19. What advice would you give another parent who recently discovered their child is struggling with anxiety?
20. How does your child's anxiety manifest? My child...(Check all that apply)
If "Other" please explain.
21. Is there anything else you would like us to know about your family's struggles with anxiety?
22. If you're open to speaking with us and receiving access to our solutions and resources, please provide your preferred email and/or phone number.
Phone
(###)
###
####
23. Would you like to receive updates from Remarkible?
