You can always press Enter⏎ to continue

This survey is confidential, and should take 10-15 minutes to complete. We're going to ask you a series of questions to help determine if Freespira is right for you. At the end of the survey, you'll have the option to enroll online, speak to a Freespira Care Advisor, or learn more about the treatment.
39Questions

HIPAA

Compliance

  • 1
    Press
    Enter
  • 2
    Press
    Enter
  • 3
    Press
    Enter
  • 4
    Learn more by watching this video or skip ahead if you'd like.
    Press
    Enter
  • 5

    Here are the benefits of using Freespira:

    • Easy to get started with 17-minute breathing sessions twice daily
    • The Freespira device is portable and can be used anywhere (e.g., at home, in the car, at the beach, etc.)
    • Treatment is 28 days but the relief is long-lasting 
    • Access to a dedicated coach who will help you along the way
    Press
    Enter
  • 6
    Press
    Enter
  • 7
    Once you're enrolled, you'll receive a kit. Each kit includes a breathing sensor that monitors your breathing during sessions. With this feedback, you'll be able to adjust your breathing patterns over 28 days to experience long-lasting relief.
    Press
    Enter
  • 8

    Did you know?

    Freespira has helped more than 7,000 patients who have suffered from panic/anxiety attacks and PTSD symptoms. Unlike many treatments, Freespira is medication-free and is completed on your schedule. In a study, 9 out of 10 patients:

    • Were panic attack-free immediately after treatment
    • Experienced long-lasting symptom relief
    • Would recommend Freespira to a friend or family member
    Press
    Enter
  • 9
    Press
    Enter
  • 10
    Press
    Enter
  • 11
    Press
    Enter
  • 12
    Press
    Enter
  • 13
    Press
    Enter
  • 14
    Press
    Enter
  • 15
    Press
    Enter
  • 16
    Please Select
    • Please Select
    • Case Manager
    • Clinician/Provider
    • Community Event
    • Direct Mailer
    • Email
    • Facebook/Instagram Ads
    • Google Ads
    • Google Search
    • News Media
    • Newsletter
    • Other
    • Phone Call
    • SMS Message
    • Social Media
    • Word of Mouth
    Press
    Enter
  • 17
    Press
    Enter
  • 18
    Let us know how you would prefer us to follow up on your question (e.g., email, text, phone call).
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 19
    We will check your insurance and help us get you started
    Press
    Enter
  • 20
    This helps us verify your insurance and get you started
    Press
    Enter
  • 21
    We use this to help verify your insurance is active.
    -
    Pick a Date
    Press
    Enter
  • 22

    Based on your insurance selection, it looks like Freespira is not a covered benefit.

    However, you can still get started with Freespira. You can file a claim with your insurance, use your FSA or HSA funds, or you can take advantage of our flexible payment plans. The cost of treatment is $2,000.

    Press
    Enter
  • 23
    Press
    Enter
  • 24
    Your answer will help us improve the journey for others.
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 25
    Press
    Enter
  • 26
    Press
    Enter
  • 27
    Press
    Enter
  • 28
    Press
    Enter
  • 29
    Press
    Enter
  • 30
    Press
    Enter
  • 31
    Please Select
    • Please Select
    • Bipolar Disorder
    • Psychosis
    • Delusional Disorder
    Press
    Enter
  • 32
    Press
    Enter
  • 33
    Press
    Enter
  • 34

    If you’re ever struggling or need crisis support, you can call or text 988 for the National Crisis and Support Lifeline. The Lifeline is available 24/7.

    Press
    Enter
  • 35

    Your safety is our top priority. We recommend you pause this survey and ask you to call or text 988, the Suicide and Crisis Lifeline. The Lifelife offers free, private support 24/7. For other types of emergencies, call 911.

    Press
    Enter
  • 36
    Press
    Enter
  • 37
    Press
    Enter
  • 38
    Press
    Enter
  • 39

    Several of the following questions refer to panic attacks and limited-symptom attacks. For this questionnaire we define a panic attack as a sudden rush of fear or discomfort accompanied by at least 4 of the symptoms listed below. In order to qualify as a sudden rush, the symptoms must peak within 10 minutes. Episodes like panic attacks but having fewer than 4 of the listed symptoms are called limited-symptom attacks.

    Press
    Enter
  • 40
    Press
    Enter
  • 41
    Press
    Enter
  • 42
    Press
    Enter
  • 43
    Press
    Enter
  • 44
    Press
    Enter
  • 45
    Press
    Enter
  • 46
    Press
    Enter
  • 47
    Press
    Enter
  • 48
    Press
    Enter
  • 49

    Below is a list of problems that people sometimes have in response to a very stressful experience. Please read each problem carefully and then circle one of the numbers to the right to indicate how much you havebbeen bothered by that problem in the past month.

    Press
    Enter
  • 50
    1 of 20
    Press
    Enter
  • 51
    Press
    Enter
  • 52
    Select all that apply
    Press
    Enter
  • 53
    Press
    Enter
  • 54
    Please include timezone
    Press
    Enter
  • 55

    We're sorry, but you are ineligible for Freespira treatment at this time. Freespira is available to individuals 18 and older. Please click Next to exit the survey.

    Press
    Enter
  • 56
    Press
    Enter
  • 57
    Press
    Enter
  • 58
    Press
    Enter
  • 59
    Press
    Enter
  • 60
    Press
    Enter
  • 61
    Press
    Enter
  • 62
    Press
    Enter
  • 63
    Press
    Enter
  • 64
    Press
    Enter
  • 65
    Press
    Enter
  • 66
    Press
    Enter
  • 67
    Press
    Enter
  • 68
    Press
    Enter
  • 69
    Press
    Enter
  • 70
    Press
    Enter
  • 71
    Press
    Enter
  • 72
    Press
    Enter
  • 73
    Press
    Enter
  • 74
    Press
    Enter
  • 75
    Press
    Enter
  • 76
    Press
    Enter
  • 77
    Press
    Enter
  • 78
    Press
    Enter
  • 79
    Press
    Enter
  • 80
    Press
    Enter
  • 81
    Press
    Enter
  • 82
    Press
    Enter
  • 83
    Press
    Enter
  • 84
    Press
    Enter
  • 85
    Press
    Enter
  • 86
    Press
    Enter
  • 87
    Press
    Enter
  • 88
    Press
    Enter
  • 89
    Press
    Enter
  • 90
    Press
    Enter
  • 91
    Press
    Enter
  • 92
    Press
    Enter
  • 93
    Press
    Enter
  • 94
    Press
    Enter
  • 95
    Press
    Enter
  • 96
    Press
    Enter
  • 97
    Press
    Enter
  • 98
    Press
    Enter
  • 99
    Press
    Enter
  • 100
    Press
    Enter
  • 101
    Press
    Enter
  • 102
    Press
    Enter
  • 103
    Please Select
    • Please Select
    • Yes
    • No
    Press
    Enter
  • 104
    Please Select
    • Please Select
    • Yes
    • No
    Press
    Enter
  • 105
    Please Select
    • Please Select
    • Phone
    • Text
    • Email
    Press
    Enter
  • 106
    PTSD
    • Please Select
    • Panic
    • PTSD
    Press
    Enter
  • 107
    Press
    Enter
  • 108
    Press
    Enter
  • 109
    Press
    Enter
  • 110
    Press
    Enter
  • 111
    Press
    Enter
  • 112
    Press
    Enter
  • 113
    Press
    Enter
  • 114
    Press
    Enter
  • 115
    No
    • Please Select
    • Yes
    • No
    • I'm not sure
    Press
    Enter
  • 116
    Press
    Enter
  • 117
    Press
    Enter
  • Should be Empty:
Question Label
1 of 117See AllGo Back
close