Mental Health Survey

Measures depression symptoms, treatment history and demographics in a single anonymous survey. Serves employers, schools and organizations that want to understand how their people are doing.

Use this template

In the Claude connectors directory

Instructions

10. If you checked off any problems, how difficult have they made things at work, at home or with other people?

1. Have you ever been diagnosed with a mental health condition by a professional (doctor, therapist, etc.)?

Yes No Not sure

2. Have you ever received treatment or support for a mental health problem?

Yes, currently Yes, in the past No

3. What are the main things contributing to your mental health problems right now? Choose up to 3.

1. Do you currently have health insurance?

Yes No Not sure

2. Do you have any of the following general health conditions? Select all that apply.

Age range

Gender

Race/ethnicity

Household income

Which of the following groups describe you? Select all that apply.

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