The Center Well Being Survey
Thank you for taking this short survey for our partners at The Center. Please read the below Screening Informed Consent and fill out the short 5 question survey. Then click for an e-signature and press submit at the bottom for a chance to win a gift card!
By completing this form, I am consenting to one of the members of the counseling program to talk to me about my symptoms and for basic demographic information and scores to be shared with a third party for grant reporting and community impact purposes. Your identity will be protected at all times. Please indicate for each of the five statements which is closest to how you have been feeling over the last two weeks. Notice that higher numbers mean better well-being.