Living Successfully Pre-Course Survey

1. Date:

2. City/State of Residence:

3. I consider myself...
Consumer/PatientFamily MemberHealth Care ProfessionalFriend/SupporterOther

4. I consider myself...
African/AmericanHispanicAsian/Pacific IslanderNative AmericanCaucasian (non-Hispanic)Other

5. My home community is...
UrbanSuburbanRuralOther

6. My age range is...
Under 1819-3031-4041-6565-75Over 75

7. I am most interested in...
Bipolar Disorder InformationDepression InformationInformation about Helping a Love OneOther:

8. My understanding level on the topic of DEPRESSION is currently:
Very HighHigh AverageLowUnsure

9. My understanding level on the topic of BIPOLAR DISORDER is currently:
Very HighHighAverageLowUnsure

10. My understanding level on the topic of TREATMENT FOR MOOD DISORDERS is currently:
Very HighHighAverageLowUnsure

11. My understanding level with the topic of PEER SUPPORT FOR MENTAL HEALTH CHALLENGES is currently:
Very HighHighAverageLowUnsure