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What is your birth date?

Your Country

Your State/Province

Zip CodeWhat is your race/ethnicity? Check all that apply.

African American or Black

Asian or Pacific Islander

Hispanic or Latinx

Native American or Alaskan Native

White

I'll write my own:

Please select at least one race/ethnicity

We are asking the questions below so we can better understand whether Q Chat Space is helping people. We may ask you these questions again after you've joined some discussion groups.

Please tell us how much you agree or disagree with the following statements.

I feel positive about my sexual/romantic orientation.

Disagree
1
2
3
4
5
6
Agree

I feel negative about my sexual/romantic orientation.

Disagree
1
2
3
4
5
6
Agree

I feel supported when it comes to my sexual/romantic orientation.

Disagree
1
2
3
4
5
6
Agree

What is your sexual/romantic orientation? Check all that apply.

Asexual

Bisexual

Gay

Lesbian

Pansexual

Queer

Straight/Heterosexual

Not sure

I'll write my own:

Please tell us how much you agree or disagree with the following statements.

I feel positive about my gender identity.

Disagree
1
2
3
4
5
6
Agree

I feel negative about my gender identity.

Disagree
1
2
3
4
5
6
Agree

I feel supported when it comes to my gender identity.

Disagree
1
2
3
4
5
6
Agree

What is your gender identity? Check all that apply.

Cis man

Cis woman

Gender fluid

Non-binary

Trans man or trans masculine

Trans woman or trans feminine

Not Sure

I'll write my own:

In the past two weeks, how often have you felt down, depressed, or hopeless?

Not at all
Several days
More than half the days
Nearly every day

Thank you!

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