How, if at all, has COVID-19 affected people outside of your family that you are close to, such as neighbors or extended family members? PLEASE CHECK ALL THE ANSWERS THAT APPLY.
What are your biggest worries for the next month? PLEASE CHECK ALL THE ANSWERS THAT APPLY.
Have you been wearing a mask when you go to the store or are near people outside your household?
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Do you have a mask to wear when you go out?
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Do you need more masks for other family members?
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We've been told to stay 6 feet apart from everyone who doesn't live in our household. Please select the one answer that best describes whether people in your neighborhood are doing that.
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If at least some people in your neighborhood are not staying 6 feet apart, why do you think they aren't doing that?
Your answer
How are you feeling emotionally? PLEASE CHECK ALL THE ANSWERS THAT APPLY.
What brings a smile to your face or helps you get through this challenging time?
Your answer
If you would like someone to follow up with you, please provide your name and phone number or email address.