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* Indicates required question
Have any of your family members been in the military?
*
Yes
No
What branch of the military were they in?
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Marines
Army
Navy
Coast Guard
Air Force
None
Required
Do you think one branch has a higher death rate than the other? If so, which one?
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Your answer
Do you know what Post Traumatic Stress Disorder is? (P.T.S.D)
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Yes
No
Have you ever heard of P.T.S.D?
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Yes
No
What are the effects of P.T.S.D? Check all that apply.
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High Stress
Flashbacks
Paranoia
Alcohol or Drug problems
Trouble Sleeping
Guilt
Relationship Problems
Hypervigilance
Social Withdrawal/Isolation
Reckless Behavior
Noise or Light irritation
Nightmares
Loss of Intrest or Pleasure
Headaches
Gambling
Feelings of Hopelessness
Eating Problems
Dizziness
Difficulty Concentrating
Confusion
Chronic Pain
Anger and Irritability
Required
Should the government pay for the treatment of P.T.S.D even after the person has left active duty?
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Yes
No
On a scale of 1-10 how serious do you think P.T.S.D is?
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Not serious
1
2
3
4
5
6
7
8
9
10
Very serious
What are somethings that you think could cause P.T.S.D?
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Your answer
What is your opinion on P.T.S.D? Would that opinion change if you knew more about it?
*
Your answer
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