Brief Norwalk Mental Health Survey
Please let us know how you are doing by completed this SHORT survey. We appreciate your time, and we will keep this survey ANONYMOUS.
1.
In what way has COVID19 affected your emotional well being?
Worse
No change/
The same
Better
2.
In what way has COVID19 affected your relationships with family and/or friends?
Worse
No change/
The same
Better
3.
Are you getting the mental health support you need right now?
Yes
No
Not sure
4.
Over the past 2 weeks how often have you been bothered by the following problems:
Not at
all
Several
days
More than half
of the days
Nearly
every day
Little interest or pleasure in doing things
Not at
all
Several
days
More than half
of the days
Nearly
every day
Feeling down, depressed, or hopeless
Not at
all
Several
days
More than half
of the days
Nearly
every day
Feeling nervous, anxious or on edge
Not at
all
Several
days
More than half
of the days
Nearly
every day
Worrying too much about different things
Not at
all
Several
days
More than half
of the days
Nearly
every day
Click here to learn about all the
counseling & peer services
in Norwalk for youth & families.
5.
How concerned are you about your child's current level of:
Not at all concerned
Slightly concerned
Very
concerned
Extremely concerned
Stress and anxiety
Not at all concerned
Slightly concerned
Very
concerned
Extremely concerned
Depression
Not at all concerned
Slightly concerned
Very
concerned
Extremely concerned
6.
The Norwalk Partnership and Norwalk ACTS are hosting a
Mental Health Walk and Wellness Fair
on May 7th (raindate May 21st). Will you come?
Yes
No
Not sure/maybe
7.
Where do you live?
Norwalk
Other
Click here to get more information on
NorWALK for Mental Health + Check-In Wellness Fair
on May 7th! Hope you can join us!
