Farming Community Mental Health Questionnaire
For men and women ages 12 years and up that are in the farming or related industry. This survey is completely voluntary and anonymous. The purpose of this brief survey is to collect basic information in order to best serve the mental health needs of the farming community. Please answer all questions as honestly and completely as possible.
What is your gender? *
What is your age? *
What best describes your relationship to the farming industry? *
Zip Code where you live:
Your answer
Do you have insurance to cover mental/behavioral health services? *
Have you or someone you know struggled with depression, suicidal thoughts, extreme/prolonged stress, or anxiety?
If "Yes" to the question above, did you/they receive the help they needed?
If "No" to the question above, why did you/they not receive the help they needed?
My mental struggles have (please check all that apply):
Have any of the following caused you stress in the last 5 years (please check all that apply)? *
Required
What options below would you be willing to try to help keep your mind healthy (please check all that apply)? *
Required
If you were to go to counseling, what would be important to you (please check all that apply)? *
Required
What is important to you about a counselor? *
Required
Please tell us anything else you would like us to know about about the mental struggles affecting you or someone you know, or anything else about how Arukah can help the mental health of the farming community.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service