#referHER Survey

Are you consistently neglecting your basic needs such as sleep, nutrition and hygiene?
Yes
No
Are you struggling to manage daily tasks that were once routine for you?
Yes
No
Have you noticed a decline in your physical health or appearance?
Yes
No
Do you find it challenging to maintain a clean and organized living space?
Yes
No
Have you experienced a significant change in your weight or eating habits?
Yes
No
Are you avoiding social interactions and withdrawing from relationships?
Yes
No
Do you neglect seeking medical care or ignore health concerns?
Yes
No
Are you facing difficulties in managing your finances or meeting basic financial obligations?
Yes
No
Have you noticed a decline in your mental health such as increased anxiety or depression?
Yes
No
Are you unable to recognize or address potential safety hazards in your environment?
Yes
No
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