Welcome

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Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Please enter a valid phone number.
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What is your preferred method of contact?* This field is required.
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What county do you currently reside in?* This field is required.United States
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How did you hear about BRIDGE?* This field is required.
Social Media
Local Newspaper
Word of Mouth
Internet
BRIDGE member
Other
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Are you aware of the BRIDGE mission and services?* This field is required.Yes
YESNO
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Which BRIDGE services are most important to you?* This field is required.
Education (College preparation, financial literacy / how to build credit, scholarships, reading programs...)
Business (Business bootcamps, marketing, exposure...)
Government (Voter education, Law education...)
Community (Diversity training, Community events, Community integration for ex integrating cemetaries....)
Health (Insurance access / education, Mental Health & Wellness workshops,)
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On a scale of 1 - 10 how important is your faith to you? (10 being very important)* This field is required.
Please Select
Please Select
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Do you rely on your faith to deal with stressful circumstances?* This field is required.Yes
YESNO
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On a scale of 1 - 10 how important is your mental health to you? (10 being very important)
Please Select
Please Select
1
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What do you do to protect your mental health?* This field is required.
Pray
See a therapist
Visit primary care doctor
Talk to a confidant
Practice wellness techniques
Do a fun activity or workout yes
Nothing
Other
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Are you aware of the mental health services available in your surrounding area?* This field is required.
YESNO
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If you clicked yes, please list 2 mental health services you are aware of.
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Who do you rely on when your mental health is compromised?* This field is required.
Friends
Family
Mental health provider
Doctor
Other
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Are there stigmas that have prevented you from getting the proper mental health care you need?* This field is required.
YESNO
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If you clicked yes, what are some of those stigmas? Choose all that apply.* This field is required.
Shame
Your faith
Cost (too expensive)
Transportation
Therapist do not look like or understand you
Other
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If you clicked other, please elaborate.
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Would you like to see and participate in more mental health focused events in the future?* This field is required.
YESNO
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On a scale of 1 - 10 how important is self care to you?* This field is required.
Please Select
Please Select
1
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10
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Please share two of your regular self care activities and wellness activities.* This field is required.
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Please share 3 things you feel would improve your lifestyle and community. (For ex, More mental health workshops, Better pay / credit, College preparation, Business exposure, Wellness events...)* This field is required.
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Ok
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If you have any additional comments, please type them below.
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