JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Healthy Mind Survey
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Your Age
*
Choose
15 - 20
20 - 30
30 - 40
40 - 50
50 - 60
60 and above
Gender
*
Male
Female
Race
Choose
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander,
White
How noisy is your daily environment?
*
Choose
Quiet
Moderate/noise
Loud/noise
How noisy is your home environment?
*
Choose
Quiet
Moderate/noise
Loud/noise
Please choose from the following Mental Health conditions you are currently struggling with.
Choose
Anger
Anxiety
Depression
Stress
Other
None
How often do you struggle with your Mental Health?
Choose
Occasionally
Daily
Weekly
Monthly
Other
Never
What is your first reaction after this listening session?
*
Negative (I don't like it)
1
2
3
4
5
Positive (I think it is valuable)
Do you feel different after this listening session?
*
Yes
No
If you were going to purchase this item, how much money would you be willing to spend?
*
Choose
Under $50
$50 - $100
$100 - $300
More than $300
Please "rate" your mood after this listening session
*
Choose
The same (no change)
Worse
Better
How would you use this kind of product?
Please tell us about activity, frequency and location of use
*
Your answer
Want to receive more information about this music? Please provide your email address.
Your answer
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
