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