AGE GROUP:
under 18
19-29
30-39
40-49
50-59
60-69
70 and over
I use the Internet (check all that apply)
To send and receive e-mail To research a topic To play games To shop for retail items To shop for personal services
Today I searched the web for (check all that apply)
Mental health services Mental health information Substance abuse services Substance abuse information Research material Other- please specify
Mental Health resource information
definitely use
might use
would not use
Substance Abuse resource information
Mental Health Assessment
Substance abuse assessment
Mental Health consultation through e-mail
Mental Health consultation through telephone
Mental Health consultation through private chat rooms
Public chat rooms
Behavioral Assessment through e-mail
How often do you read self-help/psychological material?
always
often
sometimes
rarely
never
Would you like to see reader reviews of current publications?
What topics are of the most interest to you?:
Have you ever-sought help through an online therapy service?
Yes
No
If yes, what did you think about the experience?:
Would you use a public chat room if one of the Global Therapy professionals participated in the group?
Do you have any comments or suggestions about this proposed service?:
First Name:
Last Name:
Street:
City:
State or Province:
Postal code:
Your Current Email Address: