Are you male or female?

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* 1. Are you male or female?

Which category below includes your age?

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* 2. Which category below includes your age?

What is the highest level of school you have completed or the highest degree you have received?

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* 3. What is the highest level of school you have completed or the highest degree you have received?

Which of the following categories best describes your employment status?

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* 4. Which of the following categories best describes your employment status?

In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 5. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

Do you own a drivable automobile?

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* 6. Do you own a drivable automobile?

How many children are you parent or guardian for and live in your household (aged 17 or younger only)?

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* 7. How many children are you parent or guardian for and live in your household (aged 17 or younger only)?

Are you currently enrolled as a student?

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* 8. Are you currently enrolled as a student?

In which branch (or branches) of the United States military have you served? (Check all that apply)

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* 9. In which branch (or branches) of the United States military have you served? (Check all that apply)

During your time in the military, did you serve in a reserve status, active duty, or both? (Not including deployments or basic training)

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* 10. During your time in the military, did you serve in a reserve status, active duty, or both? (Not including deployments or basic training)

Are you currently serving in the United States military, or not?

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* 11. Are you currently serving in the United States military, or not?

How many years have you served in the military, either active duty or reserve?

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* 12. How many years have you served in the military, either active duty or reserve?

0 40
i We adjusted the number you entered based on the slider’s scale.
How many months have you spent deployed to a combat zone?

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* 13. How many months have you spent deployed to a combat zone?

0 100
i We adjusted the number you entered based on the slider’s scale.
Have you been diagnosed with PTSD?

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* 14. Have you been diagnosed with PTSD?

In an average week, how many hours do you spend leisure time with your family?

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* 15. In an average week, how many hours do you spend leisure time with your family?

0 100
i We adjusted the number you entered based on the slider’s scale.
In an average week, how many hours do you spend with other Veterans (outside of working hours)?

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* 16. In an average week, how many hours do you spend with other Veterans (outside of working hours)?

0 100
i We adjusted the number you entered based on the slider’s scale.
In an average week, how many days do you feel like you have at least 3 straight hours to do something that you enjoy?

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* 17. In an average week, how many days do you feel like you have at least 3 straight hours to do something that you enjoy?

0 7
i We adjusted the number you entered based on the slider’s scale.
Do you have a quiet place to read, study, or watch television at home?

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* 18. Do you have a quiet place to read, study, or watch television at home?

Do you have any of these items at home? (Check all that apply)

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* 19. Do you have any of these items at home? (Check all that apply)

Do you enjoy cooking and have a suitable kitchen at home? (check all that apply)

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* 20. Do you enjoy cooking and have a suitable kitchen at home? (check all that apply)

In an average week, how many times do you exercise for at least 30 minutes?

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* 21. In an average week, how many times do you exercise for at least 30 minutes?

0 7
i We adjusted the number you entered based on the slider’s scale.
Do you have a local Gym membership?

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* 22. Do you have a local Gym membership?

Do you enjoy group exercise such as yoga, boot camp, or spinning?

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* 23. Do you enjoy group exercise such as yoga, boot camp, or spinning?

How many days a week do you meditate?

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* 24. How many days a week do you meditate?

Are you actively seeking mental health counseling, or would you be interested in the near future?

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* 25. Are you actively seeking mental health counseling, or would you be interested in the near future?

Are you currently seeing a chiropractor?

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* 26. Are you currently seeing a chiropractor?

Do you receive massage therapy?

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* 27. Do you receive massage therapy?

Do you receive any form of complementary healing modalities? (i.e. Aromatherapy, Healing Touch, Reflexology, Reiki, etc.)

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* 28. Do you receive any form of complementary healing modalities? (i.e. Aromatherapy, Healing Touch, Reflexology, Reiki, etc.)

Have you heard of Josh's House?

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* 29. Have you heard of Josh's House?

Would you be interested in a multi-use facility for Veterans that would provide a quiet space, entertainment options, exercise options, cooking, etc.?

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* 30. Would you be interested in a multi-use facility for Veterans that would provide a quiet space, entertainment options, exercise options, cooking, etc.?

How many miles would you be willing to travel to visit such a space on a regular basis?

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* 31. How many miles would you be willing to travel to visit such a space on a regular basis?

0 100
i We adjusted the number you entered based on the slider’s scale.
How many days in an average month do you believe that you would visit such a facility?

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* 32. How many days in an average month do you believe that you would visit such a facility?

0 30
i We adjusted the number you entered based on the slider’s scale.
How many hours do you think you would spend at such a facility on an average visit?

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* 33. How many hours do you think you would spend at such a facility on an average visit?

0 8
i We adjusted the number you entered based on the slider’s scale.
If you were a member of a multi-use facility (as described in question 30), who would you feel comfortable having access to the space?

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* 34. If you were a member of a multi-use facility (as described in question 30), who would you feel comfortable having access to the space?

Would you be willing to pay for a membership at a facility like this?

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* 35. Would you be willing to pay for a membership at a facility like this?

If yes to question 36, how much would you be willing to pay (per month)?

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* 36. If yes to question 36, how much would you be willing to pay (per month)?

$0 $100
i We adjusted the number you entered based on the slider’s scale.
Are there any specific events, services, or needs you would like to see a facility like this address/include?

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* 37. Are there any specific events, services, or needs you would like to see a facility like this address/include?

Do you have any other comments, questions, or concerns?

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* 38. Do you have any other comments, questions, or concerns?

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