Insurance Verification Form (GFV1)

*Please note: Sandstone is in network with most insurance however we do not currently accept Medicare or Medicaid.
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Stress Quiz

Free Confidential Quiz
1. Do you find yourself feeling overwhelmed or anxious in response to everyday situations or tasks?*(Required)
2. Have you noticed changes in your eating or sleeping patterns, such as difficulty falling or staying asleep or an increase or decrease in appetite?*(Required)
3. Do you frequently experience physical symptoms of stress, such as headaches, muscle tension, or stomach problems?*(Required)
4. Do you find yourself feeling irritable or easily agitated, even over minor things?*(Required)
5. Do you find it difficult to concentrate or focus on tasks that used to come easily to you? *(Required)
6. Do you have difficulty making decisions and/or do you overthink decisions that have already been made?*(Required)
7. Do you find yourself avoiding social situations or withdrawing from activities that you used to enjoy?*(Required)
8. Have you experienced an increase in the use of drugs or alcohol to cope with stress?*(Required)
9. Do you frequently feel tired or fatigued, even after getting enough sleep?*(Required)
10. Do you feel like you are constantly "on edge" or easily startled?*(Required)
11. Have you experienced stress for a prolonged period of time, such as weeks or months, and feel like you are unable to cope?*(Required)
Where should we send your confidential results?
Are you taking this for yourself or someone else?*(Required)
Name*(Required)
Email Opt In

Social Anxiety Quiz

Free Confidential Quiz
1. Do you feel nervous or fearful in social settings when you receive attention?*(Required)
2. Do you worry for days or weeks before an event where you will meet new people?*(Required)
3. Do you avoid speaking to people out of fear of embarrassment or being judged negatively?*(Required)
4. Do you experience physical symptoms like sweating, trembling, nausea, or difficulty speaking in social situations?*(Required)
5. Do you worry excessively about being embarrassed or humiliated in front of others during everyday interactions?*(Required)
6. Do you avoid making plans or even cancel your plans for fear of embarrassment or looking foolish?*(Required)
7. Do you find it difficult to make and keep friends due to nervousness, fear, or avoidance of social situations?*(Required)
8. Do you often feel that others are judging you negatively in social situations, even without clear evidence?*(Required)
9. Do you need to drink alcohol or use other substances to feel comfortable in social settings?*(Required)
10. Do you analyze your performance and identify flaws in your interactions after social events?*(Required)
11. Are any of these symptoms interfering with your everyday life?*(Required)
Where should we send your confidential results?
Are you taking this for yourself or someone else?*(Required)
Name*(Required)
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Childhood Trauma Quiz

Free Confidential Quiz
1. Do you have recurring memories or nightmares about distressing events from your childhood?*(Required)
2. Do you feel intense fear or helplessness when you remember certain childhood experiences?*(Required)
3. Have you consistently tried to avoid thoughts, feelings, or conversations related to distressing childhood events?*(Required)
4. Do you find it difficult to trust others or form close relationships because of past experiences in childhood?*(Required)
5. Do you often feel detached or emotionally numb, as if you’re not fully experiencing your emotions?*(Required)
6. Have you experienced persistent sadness, depression, or anxiety that you think might be related to your childhood?*(Required)
7. Do you often feel like you are different from others or don’t belong anywhere?*(Required)
8. Are there significant gaps in your memory regarding your childhood or specific events?*(Required)
9. Do you struggle with feelings of worthlessness or guilt that stem from childhood experiences?*(Required)
10. Have you engaged in self-destructive behavior, such as substance abuse or self-harm, which you think might be linked to past trauma?*(Required)
Where should we send your confidential results?
Are you taking this for yourself or someone else?*(Required)
Name*(Required)
Consent

Attachment Style Quiz

Free Confidential Quiz
1. How do you feel when you think about depending on others?*(Required)
2. When my partner and I argue, I...*(Required)
3. When my partner shows affection, I...*(Required)
4. When I need support, I...*(Required)
5. In new relationships, I...*(Required)
6. When thinking about my childhood, I...*(Required)
7. When my partner is away, I...*(Required)
8. When discussing future plans with my partner, I...*(Required)
9. When my partner wants to talk about feelings, I...*(Required)
10. When I think about being alone, I...*(Required)
Where should we send your confidential results?
Are you taking this for yourself or someone else?*(Required)
Name*(Required)
Outlook may block result email
Consent

ADHD Quiz

Free Confidential Quiz
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1. Do you find it difficult to focus on tasks or activities that are not very exciting or interesting to you?*(Required)
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2. Do you have trouble staying organized and often forget appointments, deadlines, or tasks you need to complete?*(Required)
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3. Do you often feel restless or find yourself fidgeting or tapping your hands or feet when you are sitting still?*(Required)
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4. Do you have difficulty waiting your turn in conversations or activities and often interrupt others or finish their sentences?*(Required)
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5. Do you frequently make careless mistakes or overlook details in your work or school assignments?*(Required)
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6. Do you struggle to complete tasks that require sustained mental effort, such as reading a book or writing a paper?*(Required)
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7. Do you find yourself getting bored easily and frequently seeking out new and stimulating activities or experiences?*(Required)
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8. Do you have difficulty following through on long-term goals or projects and often give up before they are completed?*(Required)
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9. Do you have a tendency to procrastinate or wait until the last minute to start working on important tasks?*(Required)
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10. Do you feel like your mind is constantly racing with thoughts or ideas, even when you try to relax or go to sleep?*(Required)
Where should we send your confidential results?
Are you taking this for yourself or someone else?*(Required)
Name*(Required)
Outlook may block result email
Consent

Trauma Quiz

Free Confidential Quiz
1. Have you experienced or witnessed a life-threatening event, such as a natural disaster, serious illness, Covid-19, serious accident, terrorist act, war/combat, or violence, including sexual violence?*(Required)
2. Do you often find yourself reliving the traumatic event, through flashbacks, nightmares, or intrusive thoughts?*(Required)
3. Do you avoid certain activities, places, or thoughts that remind you of the traumatic event?*(Required)
4. Do you feel constantly on guard, watchful, or easily startled?*(Required)
5. Do you feel numb or detached from people, activities, or your surroundings?*(Required)
6. Have you noticed a significant change in your interest in important activities or a decrease in feelings such as love or excitement?*(Required)
7. Do you feel irritable or have episodes of angry outbursts?*(Required)
8. Have you been feeling more sad or depressed than usual?*(Required)
9. Do you feel like you are unable to remember an important part of the traumatic event?*(Required)
10. Do you feel like your future will somehow be cut short?*(Required)
Where should we send your confidential results?
Name*(Required)
Consent

Anxiety Quiz

Free Confidential Quiz
1. Do you constantly fear or worry about your everyday tasks, events, or activities?*(Required)
2. Do you feel tense, on edge, irritable, or easily worn out?*(Required)
3. Do you have trouble sleeping, concentrating, or making decisions because of anxiety or worry?*(Required)
4. When dealing with stressful situations, do you experience physical symptoms such as a rapid heartbeat, sweating, or shaking?*(Required)
5. Do you avoid certain situations or activities because of your anxiety?*(Required)
6. Do your fears or worries interfere with your daily life and activities?*(Required)
7. Have you experienced panic attacks or intense fear in situations where others do not feel the same way?*(Required)
Where should we send your confidential results?
Are you taking this for yourself or someone else?*(Required)
Name*(Required)
Consent

Depression Quiz

Free Confidential Quiz
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1. Do you feel sad or down most of the time?*(Required)
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2. Have you lost interest in activities that you used to enjoy?*(Required)
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3. Do you have difficulty sleeping, either trouble falling asleep or staying asleep?*(Required)
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4. Do you have difficulty concentrating or making decisions?*(Required)
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5. Do you have a change in appetite, either eating more or less than usual?*(Required)
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6. Do you feel tired or have low energy most of the time?*(Required)
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7. Do you feel worthless or guilty for no apparent reason?*(Required)
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8. Do you have thoughts of death or suicide?*(Required)
Where should we send your confidential results?
Are you taking this for yourself or someone else?*(Required)
Name*(Required)
Outlook may block result email
Consent

Alcohol Quiz

Free Confidential Quiz
1. Do you drink alcohol regularly, or do you binge drink?*(Required)
2. Do you feel like you need to drink in order to cope with stress or difficult emotions?*(Required)
3. Do you drink alcohol even when it causes problems in your personal or professional life?*(Required)
4. Have you tried to cut back on your drinking or stop drinking, but been unable to do so?*(Required)
5. Do you experience withdrawal symptoms when you stop drinking, such as tremors, sweating, or anxiety?*(Required)
6. Have you continued to drink even though it has caused health problems for you?*(Required)
7. Do you prioritize drinking over other activities or responsibilities?*(Required)
Where should we send your confidential results?
Are you taking this for yourself or someone else?*(Required)
Name*(Required)
Consent

Internet Addiction Quiz

Free Confidential Quiz
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1. Do you notice that you spend more time on your phone, computer, or other devices than you meant to?*(Required)
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2. Do you feel anxious or restless when you aren’t able to go online?*(Required)
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3. Do you prioritize being online over spending time with loved ones or other responsibilities?*(Required)
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4. Do you use the internet as a way to escape from reality or avoid dealing with difficult emotions and situations?*(Required)
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5. Do you use your devices in a way that interferes with your work, school, or personal relationships?*(Required)
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6. Have you tried to cut back on or set limits for your time online, but have been unable to do so?*(Required)
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7. Do you find that the time you spend online is causing problems in your personal or work life, but you continue to use them anyway?*(Required)
Where should we send your confidential results?
Are you taking this for yourself or someone else?*(Required)
Name*(Required)
Outlook may block result email
Consent

Support Quiz

Step 1 of 10

Free Confidential Quiz
Which support are you most interested in?*(Required)

SC - Contact Us (New Website)

Name(Required)
We will respond to you within 24 hours.

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Feedback

Satisfaction Survey

Please provide feedback on your interaction with us so we can continue to improve our customer experience.

Name*(Required)
How likely are you to recommend Sandstone Care to a friend or family member?*(Required)

Parent Support Group Signup

Join A Free Virtual Parent Support Group
Which group are you interested in?*(Required)

Sandstone Care Scholarship Application 2025

Sandstone Care


 Scholarship Application
Name*(Required)
Address*(Required)
Which option best describes you?*(Required)
Make sure the share settings is "Anyone with the link can view." This allows Sandstone to view the video. The link will not be shared publicly.
How to change the share settings on Google Drive
  • Upload the file to Google Drive
  • Click the person+ icon on the top right corner
  • Click "Restricted" and change the drop-down option to "Anyone with the link"
How to upload Youtube Video
  • Upload the file to Youtube by clicking the "+ video icon" on the top right corner
  • Add "2025 Sandstone Care Scholarship Application" to the title field
  • Select "No it's not made for kids" under audience
  • Click Next until you see "Visibility" section
  • Select "Unlisted" under save and publish
  • Copy the sharing link and paste it above
Help Us Fight Stigma
(Required)

If you have any questions please email: [email protected]

Verify Insurance(888) 850-1890