emme Screening Questionnaire

    All fields are required.

    Do you live in Bridgeport?

    Are you an Optimus Health Care patient?

    Do you self-identify as female?

    Are you currently pregnant?

    Do you have any goals or dreams for your life that you are having difficulty achieving?

    Have you tried anything previously to make progress towards reaching your goals?

    Do you speak a language other than English? If so, please specify.