None of your answers can be traced back to you. This survey is completely anonymous. No attempt will be made to find out who any of the respondents of this survey are. You do not need to answer all of the questions if you do not wish to but please remember that it is a lot more helpful to us if you do.


Please answer the following questions with regard to yourself:

* 1. Have you ever received counselling or therapeutic listening for any of the following? (Select all that apply)

* 2. Have you ever felt that you would like to have, but haven't, received counselling or therapeutic listening for any of the following? (Select all that apply)

T