TAIBU Healing Circles Project Question Title * 1. What is your first name? Question Title * 2. How old are you? 12 and under 13 - 17 18 - 24 25 -34 35 - 54 55 to 64 65 and older Question Title * 3. Where do you live? (For example, Toronto, Mississauga, Scarborough, Ajax) Question Title * 4. Do you identify as Black? Yes No Question Title * 5. What is your background? African African-American Canadian Caribbean/West Indian Franco-africain(e) Other (please specify) Question Title * 6. Have you accessed any mental health services in the last 6 months- 12 months? Question Title * 7. How would you describe your experiences accessing mental health services? Question Title * 8. As a Black person, what do you need to support your mental health? Question Title * 9. Are you a service provider who identifies as Black serves Black communities identifies as Black and serves Black communities I am not a service provider Question Title * 10. Have you ever participated in a healing circle? Yes No Question Title * 11. Would you be comfortable participating in a healing circle? Yes No Question Title * 12. If you are interested in participating in TAIBU's Healing Circle Project please attach your contact information in the space provided. Done
