Northern Hope Center Questionnaire

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Do you tend to isolate yourself? *

Yes

Do you feel overwhelmed with daily activities? *

Yes

Do you avoid close relationships when you are stressed? *

Yes

Do you feel that you do not fit in anywhere? *

Yes

Have you been diagnosed with a mental illness? *

Yes

Has this mental illness caused significant impairment in work or school? *

Yes

Has this mental illness caused significant impairment with your family or social life? *

Yes

Has this mental illness caused significant impairment in hygiene or self care? *

Yes

Are your significant impairments caused primarily by drug or substance abuse? *

Yes

Do you feel a mental health drop in center would improve your well being? *

Yes

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