Section 1 of 1
Shadow Work Registration
Name
Name
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Date
Time
Number
Text
Length
Regular expression
Contains
Doesn't contain
Email
URL
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Email Address
Email Address
Question Type
Short answer
Paragraph
Multiple choice
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Dropdown
File upload
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Checkbox grid
Date
Time
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Birthdate
Birthdate
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Short answer
Paragraph
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Multiple choice grid
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Date
Time
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Contact no.
Contact no.
Question Type
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Paragraph
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Checkbox grid
Date
Time
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Address
Address
Question Type
Short answer
Paragraph
Multiple choice
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Dropdown
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Checkbox grid
Date
Time
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Currently Employed? Yes
Currently Employed? Yes
Question Type
Short answer
Paragraph
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File upload
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Checkbox grid
Date
Time
No
Yes
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add "Other"
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Marital Status
Marital Status
Question Type
Short answer
Paragraph
Multiple choice
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Date
Time
It's complicated
Single
Married
Separated
Widowed
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What 3 things would you like address during this program?
What 3 things would you like address during this program?
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Date
Time
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Why is it important that you address these issues now?
Why is it important that you address these issues now?
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Date
Time
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What medical conditions have you been diagnosed with (currently and in the past)? -
What medical conditions have you been diagnosed with (currently and in the past)? -
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Paragraph
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Date
Time
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Are you currently taking any medication? If so, for which condition
Are you currently taking any medication? If so, for which condition
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Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
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Checkbox grid
Date
Time
Answer key
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Have you ever felt suicidal or had suicidal thoughts in the past? - Kinda
Have you ever felt suicidal or had suicidal thoughts in the past? - Kinda
Question Type
Short answer
Paragraph
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Checkboxes
Dropdown
File upload
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Multiple choice grid
Checkbox grid
Date
Time
Yes
No
Kinda
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add "Other"
…
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