*1.Which emotion best describes you right now?(Required.)

Tired

Numb

Sad

Angry

Anxious

Grateful

Hopeful

I don't know

2.How heavy does your mind feel today?

Clear and calm

Bit foggy

Heavy and full

Completely overwhelmed

*3.Do you feel emotionally supported right now?(Required.)

Yes, I have support

Somewhat

No, I'm not supported

4.When was the last time you felt truly rested?

Last night

This week

I can't remember

I've never felt rested as a mother

*5.What part of being a mum feels hardest right now?
(Choose as many as needed)(Required.)

Guilt

Loneliness

Physical pain or recovery

Mental health

Grief or past trauma

Parenting demands

Feeling unseen

Other (please specify)

*6.When was the last time you did something just for you?(Required.)

Today

Last week

This month

I don't remember

*7.Choose one word or feeling you want to leave with today:(Required.)

Hope

Calm

Joyful

Love

Supported

Comfort

Strength

Courage

Nothing — I just needed to be here.

*8.What is being a mother to you mean?(Required.)

9.Is there anything you wish you could say out loud about being a mum — but don’t feel safe to? (No judgement, this is for you)

*10.Do you need extra support or referrals made? (Let staff know, what you need!)(Required.)

Yes please

No thanks