Mental Health Questionnaire
This is a survey about Mental Heath! It should take 3-7 minutes to complete this questionnaire. Please answer the questions honestly.
1. How old are you?
2. What country and state do you live in? (If you prefer not to say, leave blank.)
3. What mental illness do you struggle with? (If you have multiple diagnoses, check the ones that apply to you.)
Anxiety (i.e. Social Anxiety, Generalized Anxiety, Panic Disorder)
An Eating disorder (i.e. Bulimia Nervosa, Anorexia Nervosa, Binge-eating Disorder)
OCD (Obsessive-Compulsion Disorder)
PTSD (Post-Traumatic Stress Disorder)
4. Do you Self-harm?
I am recovering!!!
No, I've never self-harm.
5. Do you tend to have suicidal thoughts?
Yes, all the time.
No, not really
I've never had suicidal thoughts.
6. Are you seeking professional help and(or) taking medication?
Yes, but I am only seeing a therapist.
Yes, but I am only taking medication.
Yes, I am seeing a therapist & taking medication.
Not yet receiving help/waiting to
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