Spirituality Survey-Provider version Question Title * 1. Are you a... BHRS staff member Community provider Question Title * 2. What is your age? 18-25 26-36 37-47 48-57 57-70 70+ Question Title * 3. Are you a... LCSW MFT LPCC Psychologist Psychiatrist Administrative staff Case manager (not licensed) Other...Please Specify Below Other (please specify) Question Title * 4. How do you identify your gender? Female Male Transgender Gender non-conforming Other...Please Specify Below Other (please specify) Question Title * 5. How do you identify your sexual orientation? Gay/Lesbian Straight Bisexual Asexual Pansexual Other...Please Specify Below Other (please specify) Question Title * 6. How do you identify your ethnicity/race? African American/Black American Native/Alaskan Native Chinese Filipino Guamanian Hispanic/Latino(a) Hmong Japanese Korean Middle Eastern/Arab Native Hawaiian Samoan Tongan Other Asian Ethnicity Other Pacific Islander Vietnamese White/European More than one race/ethnicity Other...Please specify Below Other (please specify) Question Title * 7. What is your primary language? English Spanish Chinese Korean Japanese Vietnamese Tagolog Russian Farsi German French Other...Please Specify Below Other (please specify) Question Title * 8. In which region do you provide services? Central County: San Mateo, Foster City, Belmont, Burlingame, Hillsborough South County: San Carlos, Redwood City, Woodside, Atherton, West Menlo Park, Portola Valley North County: Daly City, Pacifica, Colma, Brisbane, South San Francisco, San Bruno, Millbrae East Palo Alto: East Palo Alto, East Menlo Park Coastside: Half Moon Bay, Pescadero, La Honda Other region within San Mateo County Behavioral Health and Recovery services: Examples include therapeutic day schools, youth services Bureau, AOD treatment, etc Question Title * 9. How long have you worked in this field? 0-6 months 6 months-1 year 1-5 years 6-10 years 10-14 years 15 years+ Question Title * 10. Do you identify with any of the following? Check the most important spiritual practice to you, and add another in the box if you identify with more than one. Agnostism Atheism Buddhism Christianity Earth based Hinduism Islam Judaism Native American spiritual tradition Nothing Shamanism Unitarian Universalism Other...Please Specify Below Other (please specify) Next