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Ballroom, We Care 2023
Ballroom Focused Survey
OK
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1.
Age
(Required.)
Under 18
18-24
25-34
35-44
45-54
55-64
65+
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2.
Please enter your zipcode below?
(Required.)
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3.
What is your gender identity?
(Required.)
Female
Male
Genderqueer or Gender Nonconforming
Transgender - MtF
Transgender - FtM
Agender
Two Spirit
Not specified above, please specify
4.
What is your sex assigned a birth?
Male
Female
5.
What is your sexual orientation?
Asexual
Bisexual
Gay
Heterosexual or straight
Lesbian
Pansexual
Queer
Same Gender Loving
None of the above, please specify
6.
Which race/ethnicity best describes you? (Please choose only one.)
American Indian or Alaskan Native
Afro-Latinx
Asian/Pacific Islander
Black/African-American
Hispanic
White / Caucasian
Other (please specify)
7.
Which Ballroom-scene are you affiliated with?
Please select which group below
Main Ballroom Scene
Kiki Scene
Both
No affiliation
8.
Have you heard of crystal meth or Tina?
Yes
No
9.
Are you familiar with Ballroom, We Care, and the work we do?
Yes
No
10.
How useful are the services provided by Ballroom, We Care?
Extremely useful
Very useful
Somewhat useful
Not so useful
Not at all useful
Not sure
11.
How important are services for meth, and Tina in the Ballroom Community?
Extremely important
Very important
Somewhat important
Not so important
Not at all important
Not sure
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12.
Do you know anyone in the Ballroom Community currently using crystal meth, or Tina?
(Required.)
Yes
No
Not sure
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13.
Do you know anyone in the Ballroom who is addicted to meth or Tina?
(Required.)
Yes
No
Not sure
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14.
Have you tried meth or Tina?
(Required.)
Yes
No
Not sure
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15.
Do you know anyone in Ballroom who may have died due to meth or Tina use?
(Required.)
Yes
No
Not sure
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16.
Which of the following services would you like to see more of when it comes to meth, or Tina use and mental health-related issues in Ballroom? Choose all that apply
(Required.)
Inpatient and outpatient substance use treatment programs tailored to the needs of Ballroom
Harm reduction services ( like safer approaches to using) for individuals using meth tailored to the needs of Ballroom
Individual and group counseling services( space to help process thoughts/feelings about meth use) tailored to the needs of Ballroom.
Psychotherapy( talk therapy)
Psychiatry(medication treatment)
17.
Would you like to see a state or nationwide crystal meth awareness/education campaign for this community?
Yes
No
Not sure
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18.
Do you need any assistance or resources for yourself or a loved one struggling with crystal meth or mental health issues? If yes, please leave your email in the section below. All responses are anonymous
(Required.)
No
Yes, please provide email address below
Email
Current Progress,
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