If you or someone you know may be experiencing sexual violence or assault, please call the National Sexual Assault Hotline: CALL 800.656.HOPE (4673) or call 911, reporting can save a life.

Empowering Survivors. Breaking the Silence.

Donate

A Supportive Step Toward Healing

Mental Health Screening

As part of the application process for Ketamine-Assisted Psychotherapy (KAP) funding through United Voices Rising, we ask each applicant to complete a confidential mental health screening. This helps our team better understand your current needs and determine whether KAP is a safe, supportive fit.

This screening is not a diagnosis—it’s simply a tool. Your responses help guide our process and protect your well-being.

What This Screening Includes:

This brief form includes questions from three clinically recognized assessments:

  • GAD-7 – measures symptoms of anxiety
  • PHQ-9 – screens for symptoms of depression
  • PCL-5 – evaluates symptoms related to trauma and PTSD

You’ll be asked how often you’ve experienced specific thoughts or symptoms over the past 2–4 weeks. Most questions are answered on a simple 0–3 or 0–4 scale.