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Veteran Mental Health Services

Are you a Veteran or currently enlisted?
Yes
No
Which branch of the Armed Forces did you serve?
Army
Navy
Air Force
Marines
Coast Guard
National Guard
Reserves
Other
How long were you in the service?
Less than one year
2-5 years
6-11 years
12-18 years
18-24 years
25+ years
Which military event were you involved in?
World War II
Korean War
Cold War
Vietnam War
Gulf War
Iraq/Afghanistan War (War on Terror)
Other
Were you enlisted or commissioned?
Enlisted
Commissioned
Other
What was your Military Occupational Specialty (MOS)?
Were you deployed to a combat zone?
Yes
No
What kind of issues did you experience when you separated from the military?
Rate returning to a civilian life on a scale of 1 = Excruciatingly difficult to 10 = Easiest thing ever done.
1
2
3
4
5
6
7
8
9
10
How would you rate your experience with job placement after you separated? 1 = Excruciatingly difficult to 10 = Easiest thing ever done.
1
2
3
4
5
6
7
8
9
10
Do you receive services through the Department of Veterans Affairs (V.A.)?
Yes
No
If yes, would you like to elaborate on which V.A. Services you use?
While in service, either deployed, in garrison or during training, did you experience a traumatic event?
Yes
No
Have you been diagnosed with PTSD?
Yes
No
If not diagnosed, do you believe you suffer from PTSD?
Yes
No
Not sure
Has PTSD negatively affected your personal, family, social or work environment?
Have you had thoughts of suicide or harming yourself or others?
Yes
No
Do you utilize counseling and/or mental health services offered?
Yes
No
How satisfied are you with the current mental health (MH) program?
Extremely satisfied
Very satisfied
Satisfied
Neither satisfied not dissatisfied
Dissatisfied
Very dissatisfied
Extremely dissatisfied
What would you do differently if you ran the program?
What additional options would you like to see in an MH/counseling program?
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