Mental Health Survey #1 (2019-2020)
Program ID
What zip code do you live in?
If you don't know your zip code, please specify what city and neighborhood you live in.
Age Group
Clear selection
Gender
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What is your sexual orientation?
Do you consider yourself to be transgender or transsexual?
Clear selection
Are you Hispanic or Latino/a
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What is your race? (Check all that apply)
What is the main language you speak at home?
What is the highest level of education you have completed? (Please check only one)
Clear selection
Do you currently have health insurance?
Clear selection
Are you currently working? (Please check only one)
Clear selection
In the past year, how often did you worry about having enough money to pay for food or housing?
Clear selection
In the past year, which of the following health concerns did you face? (You may check more than one)
Have you ever received services from a doctor and/or mental health professional for depression, or anxiety?
Clear selection
Have you ever been hospitalized because of a mental health issue?
Clear selection
Has anyone close to you (e.g., a parent, sibling, spouse, etc.) ever suffered from depression, anxiety, or mental illness of any kind?
Clear selection
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