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ADOLOSCENT SELF ASSESSMENT

It can be overwhelming when things feel "off" or when you realize you might need extra support for your mental health. We’ve designed these self-assessments specifically for young people to help you identify what you’re experiencing and determine if professional guidance could help you get back on track.

Please answer the following 21 questions for the self-assessment:

OVER THE LAST 2 WEEKS, HAVE YOU NOTICED YOURSELF:
OVER THE LAST 2 WEEKS, HAVE YOU NOTICED YOURSELF:
OVER THE LAST 2 WEEKS, HAVE YOU NOTICED YOURSELF:
OVER THE LAST 2 WEEKS, HAVE YOU NOTICED YOURSELF:

Thank you for completing the self-assessment

Based on your answers, we recommend that we call or email you with further assistance.

Alternatively, call us on 031 761 8766.

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We look forward to hosting you for an evening of insight, collaboration, and connection. Please confirm your attendance below.

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I declare that the information provided in this application is true and correct to the best of my knowledge. I understand that admission to Medilution Wellness Retreat is subject to a clinical assessment by qualified professionals. I hereby consent to undergo any necessary medical, psychological, and therapeutic evaluations required to determine my suitability for the program. I also acknowledge that all personal and medical information will be kept confidential in accordance with applicable privacy laws and ethical standards. By signing below, I agree to abide by the rules, regulations, and guidelines of Medilution Wellness Retreat and understand that failure to comply may affect my participation in the program.