DriveEase - M Health

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DriveEase™ Clarity & Readiness

First — I’m proud of you for even being here.Driving anxiety is far more common than most people admit, but staying stuck does not have to be permanent. This form is designed to help bring clarity to where you are right now, where you want to be, and whether you are truly ready to move toward calm, confident driving.

Section 1: Where are you right now?

On a scale of 1–10, how intense is your driving anxiety?

{"type":"text","name":"__generic","width":100,"value":"","size":"Normal","validation":"TN","validationMessage":"Please enter a number.","placeholder":"(1 = mild unease, 10 = full panic response)"}

Q2. What specifically triggers it? (select all that apply)

Highways / high speeds Merging Left turns / busy intersections Being a passenger's fear too (anticipatory anxiety before even driving) Fear of causing or being in an accident "What if" spiral thoughts, even before getting in the car Night driving or bad weather I haven't driven long enough to know yet Something else (open text — only field that stays open){"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Highways / high speeds\nMerging\nLeft turns / busy intersections\nBeing a passenger's fear too (anticipatory anxiety before even driving)\nFear of causing or being in an accident\n\"What if\" spiral thoughts, even before getting in the car\nNight driving or bad weather\nI haven't driven long enough to know yet\nSomething else (open text — only field that stays open)"}

Q3. When did this start?

I've never felt fully comfortable driving After a specific accident or near-miss It built up gradually over time After a long break from driving It started as general anxiety and driving became part of it{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"I've never felt fully comfortable driving\nAfter a specific accident or near-miss\nIt built up gradually over time\nAfter a long break from driving\nIt started as general anxiety and driving became part of it"}

Q4. How is this currently showing up in your life? (select all that apply)

Turning down jobs, plans, or invitations that require driving Relying on other people to drive me Avoiding specific routes (highway, certain intersections) Constant background stress even when I'm not driving It's affecting a relationship or my independence Mental energy — I think about this more than I'd like to admit{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Turning down jobs, plans, or invitations that require driving\nRelying on other people to drive me\nAvoiding specific routes (highway, certain intersections)\nConstant background stress even when I'm not driving\nIt's affecting a relationship or my independence\nMental energy — I think about this more than I'd like to admit"}

Section 2 — Where you want to be

Q5. In 90 days, if this were resolved, what would change first?

I'd take the highway without dreading it I'd stop avoiding routes/situations I'd drive somewhere specific I've been putting off (open text, optional) I'd feel like myself again behind the wheel — like before the accident I'd finally get my licence / stop relying on others{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"I'd take the highway without dreading it\nI'd stop avoiding routes/situations\nI'd drive somewhere specific I've been putting off (open text, optional)\nI'd feel like myself again behind the wheel — like before the accident\nI'd finally get my licence / stop relying on others"}

Q6. What do you think is really underneath this — the actual block?

Fear of losing control Fear of another accident happening A bad first learning experience (harsh instructor/parent) General anxiety that shows up everywhere, not just driving Honestly not sure — that's part of why I'm here{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Fear of losing control\nFear of another accident happening\nA bad first learning experience (harsh instructor/parent)\nGeneral anxiety that shows up everywhere, not just driving\nHonestly not sure — that's part of why I'm here"}

Section 3 — Readiness

Q7. Which feels most true right now?

I'm ready to commit time and energy to working through this I'm interested, but I have real doubts or fears about the process I'm not sure I'm ready to let go of the fear yet — and that's okay{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"I'm ready to commit time and energy to working through this\nI'm interested, but I have real doubts or fears about the process\nI'm not sure I'm ready to let go of the fear yet — and that's okay"}

Q8. What would help you take the next step? (select all that apply — this replaces guessing at follow-up)

Talking to a real person first, no pressure Understanding pricing before I decide anything Knowing I can start virtually, without getting in a car yet Knowing exactly what a first session looks like I'm ready to book — just show me times{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Talking to a real person first, no pressure\nUnderstanding pricing before I decide anything\nKnowing I can start virtually, without getting in a car yet\nKnowing exactly what a first session looks like\nI'm ready to book — just show me times"}

Thank you for your honesty. Acknowledging fear takes honesty. Facing it takes courage. Changing it takes commitment. We'll be in touch shortly with the right next step for you — no pressure, no pitch.