Behavioral Health Questionnaire

(360) 716-4400

1. How long have you been receiving counseling through tulalip?

Please select the clinic used

Family Services

Child Youth and Family Services

2. How long have you been working with your current therapist?

3. During the Covid-19 pandemic, do you feel like your mental wellness has improved or declined?

Improved

Declined

Comment

4. How much has your mental wellness improved or declined during the pandemic?

Choose -2 to +2. -2 means "Declining" +2 means "improving"

-2

-1

Comments

5. What types of counseling sessions have you used as a result of the pandemic?

Choose all that apply

Telephone

Zoom

In Person

6. If you have only experienced one form of therapy during the pandemic, why have you chosen that form?

7. Have you experienced any technical difficulties that have negatively affected your therapy?

Yes

Comments

8. If you could choose one preferred way of doing counseling, which one would you prefer and why?

Telephone

Zoom

In Person

Doesn't Matter

Why?

Please provide the reason for the preference.

9. If you have used zoom or telephone due to the pandemic, how has this impacted your care?

10. How respected and valued do you feel by your therapist?

Choose 1-5. 1 means "Not at all" 5 means "The most"

11. Do you feel that your therapist has a good understanding of your needs and reasons for seeking help?

Yes

Comments

12. Do you feel that your therapy is positively impacting your situation?

Yes

Comments

13. What types of symptoms have you experienced since the beginning of the pandemic?

For example; anxiety, depression, anger

14. Would you feel confidant referring a friend or family member to the Adult Mental Wellness team?

Select

Comments

15. What might improve therapy sessions?

16. What types of therapies or resources would you like to have access to?

17. Do you have any other general comments for our department?

Demographics

What is your gender?

Male

Female

Other (Please self-identify)

Age

Are you a Tulalip Tribal Member?

Yes

Other Native

Other (Please Specify)

Other

Contact (Optional)

Would you like someone from Adult Mental Wellness to contact you?

Phone (Optional)

Email (Optional)

Send me a copy of my responses

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