Mental Health Survey

Question Title

* 1. How old are you?

Under 18

18-30

31-40

41-50

51-60

61-70

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* 2. What is your name? If you want to remain anonymous use a fake name. Your responses (or part of them) may be published.

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* 3. What is your gender?

Female

Male

I'd rather not share

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* 4. Overall how would you rate your mental health?

Excellent

Very good

Good

Fair

Poor

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* 5. During the past two weeks how often have you felt sad or depressed?

Extremely often

Very often

Somewhat often

Not so often

Not at all often

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* 6. During the past two weeks how often has your mental health interfered with your personal relationships?

Extremely often

Very often

Somewhat often

Not so often

Not at all often

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* 7. During the past two weeks how often has your mental health interfered with your ability to get work done or accomplish tasks?

Extremely often

Very often

Somewhat often

Not so often

Not at all often

Mental Health Survey

Question Title

* 1. How old are you?

Question Title

* 2. What is your name? If you want to remain anonymous use a fake name. Your responses (or part of them) may be published.

Question Title

* 3. What is your gender?

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* 4. Overall how would you rate your mental health?

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* 5. During the past two weeks how often have you felt sad or depressed?

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* 6. During the past two weeks how often has your mental health interfered with your personal relationships?

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* 7. During the past two weeks how often has your mental health interfered with your ability to get work done or accomplish tasks?

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* 8. What are some of the things you tell yourself about yourself?

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* 9. Do you have any comments or suggestions to make Beyond Blue Club better?