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Needs Assessment Survey

Thank you for taking the time to complete this survey!

The purpose of this survey is to better understand your community’s behavioral health needs.

This survey will take about 6 minutes to complete, and your responses will remain confidential.

Demographics

*1.How old are you?(Required.)

18-24 years

25-34 years

35-44 years

45-54 years

55-64 years

65 years and older

*2.What is your sex?(Required.)

Male

Female

Prefer not to say

*3.What is your race or ethnicity? You can pick more than one.(Required.)

American Indian or Alaska Native

Asian or Asian American

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Another Pacific Islander

White or Caucasian

Two or More Races

Another race, please specify

*4.Have you ever gotten mental health or substance use help in McKinley County?(Required.)

Yes

No

Prefer not to answer

*5. Are you a service provider in McKinley County?(Required.)

Yes

No

Prefer not to answer

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