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Behavioral Health Demographics

If you are taking this on behalf of a loved one, please note that all of these questions will be phrased as if that person were taking this screening.

What is your age? *This question is required.
What is your gender identity? *This question is required.
What is your partnership status? *This question is required.
Which of the following best describes your sexual orientation? *This question is required.
What is your racial/ethnic identity? *This question is required.
What is the highest level of education you have completed? *This question is required.
Have you experienced any major changes, positive or negative, in your personal or work life in the last six months such as marriage, divorce, birth of a child, promotion, job change, etc.? *This question is required.
Do you have caregiver responsibilities? For example, caring for a partner, child, parent, family member, etc.?  *This question is required.
Have you ever received professional behavioral health care (e.g. for depression, PTSD, anxiety, eating disorder)? *This question is required.
Do you suffer from a chronic medical condition such as diabetes, hypertension, etc.?  *This question is required.
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