The Online Men’s Behaviour Change Program (OMBCP) Survey Question Title * 1. Are you: Interested in doing the program yourself? Enquiring on behalf of someone who might do the program Neither of the above (please explain your interest) Question Title * 2. Why do you (or the person you are enquiring for) want or need to do the program? (Please tick all that apply). Because of a Court or Departmental Order, including AVOs, Parenting Orders and similar obligations On legal advice Personal development My partner wants me to do it I want to have access to my children Other (please specify) Question Title * 3. Why do you (or the person you are enquiring for) want to do the program online and not in a face to face group? (Please tick all that apply). The nearest face to face men’s behaviour change groups are too far away Nearby groups are booked out I travel for work/fly in/fly out and can’t attend in person Other types of work commitments mean that I can’t attend a group venue regularly I would feel more comfortable with an online interaction I need to be anonymous in my community for business or other reasons Other (please tell us) Question Title * 4. My capacity to pay to attend the program based on my income would be (please tick one): Nil Up to $500 Up to $1,000 Up to another amount About You (If you are not the person wanting to do the program, please answer these questions to the best of your ability on their behalf) Question Title * 5. Details Your postcode Your age Question Title * 6. Your relationship status (please tick all that apply): Married or partnered Separated Divorced Never partnered Living with a partner Not living with a partner Living with a partner (some of the time) Other (please specify) Question Title * 7. Do you have any children? Yes No Next