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Mental Health Survey
*
1.
How old are you?
(Required.)
Under 18
18-30
31-40
41-50
51-60
61-70
2.
What is your name? If you want to remain anonymous use a fake name. Your responses (or part of them) may be published.
*
3.
What is your gender?
(Required.)
Female
Male
I'd rather not share
*
4.
Overall how would you rate your mental health?
(Required.)
Excellent
Very good
Good
Fair
Poor
*
5.
During the past two weeks how often have you felt sad or depressed?
(Required.)
Extremely often
Very often
Somewhat often
Not so often
Not at all often
*
6.
During the past two weeks how often has your mental health interfered with your personal relationships?
(Required.)
Extremely often
Very often
Somewhat often
Not so often
Not at all often
*
7.
During the past two weeks how often has your mental health interfered with your ability to get work done or accomplish tasks?
(Required.)
Extremely often
Very often
Somewhat often
Not so often
Not at all often
8.
What are some of the things you tell yourself about yourself?
9.
Do you have any comments or suggestions to make Beyond Blue Club better?
Current Progress,
0 of 9 answered