Mental Health Services Access Survey

Mental Health Services Access Survey — Form Fields

This surveys template includes 8 fields. Explore community awareness and barriers to accessing mental health services. Free to customize and use on ZenBuild.

• Age group (dropdown selection, required) — options: 18-24, 25-34, 35-44, 45-54, 55-64, 65+
• Have you ever sought mental health services? (multiple choice, required) — options: Yes, currently, Yes, in the past, No, but considered it, No
• Barriers to accessing mental health care (checkboxes, optional) — options: Cost/Insurance, Long Wait Times, Stigma, Lack of Providers, Not Knowing Where to Start, Privacy Concerns, None
• Awareness of Available Mental Health Resources in Your Community (rating, required)
• Do you feel your employer supports mental health? (multiple choice, optional) — options: Very supportive, Somewhat supportive, Not supportive, I'm not employed
• What would make mental health services more accessible to you? (long text, optional)
• Overall Community Mental Health Support Rating (rating, required)
• Would you be comfortable using telehealth for mental health? (multiple choice, required) — options: Yes, Maybe, No