Intake form

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What is your age range?

What best describes your mental health status?

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Anxiety

Depression

Bipolar Disorder

Schizophrenia

Post-Traumatic Stress Disorder (PTSD)

None of the above

Do you have any physical disabilities?

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Mobility Impairments

Vision Impairments

Hearing Impairments

Chronic Illness

None of the above

What types of relationships are you interested in?

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Friendship

Romantic Relationship

Supportive Connection

Are you currently in recovery from a substance use disorder?

What features are you most interested in using on our platform?

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Profiles

Messaging

Video Calls

Events

Community Forums

How did you hear about stigma love?

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Social Media

Friend/Family Referral

Online Search

Mental Health Professional

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Additional questions or comments

Stigma Love