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Exit Survey
 
 
Please state your gender?
 
Male
 
Female
 
 
 
Which of the following age groups do you fall into?
 
0-18
 
18-30
 
30-40
 
40-50
 
>50
 
 
 
Which of the following best describes your marital status?
 
Single
 
Co-habiting
 
Lone parent
 
Married (with children)
 
Married (with step-children)
 
Other
 
 
 
 
What is your highest level of educational achievement?
 
Primary school
 
Secondary school
 
University degree
 
 
 
Which of the following best describes your current employment status?
 
Full time employment
 
Part time employment
 
Occasional work
 
Unemployed
 
 
 
Do you suffer from any of the following mental health conditions?
 
Depression
 
Anxiety
 
Social Phobia
 
Specific phobia
 
Post Traumatic Stress Disorder
 
Other
 
 
 
Do you regularly (at least 3 times a week) participate in any of the following activities? (You may choose more than one)
 
Smoke
 
Drink alcohol
 
Use drugs

 
 
 
Do you feel able to tell family or friends about your condition?
 
Yes
 
No
 
 
 
If you answered "No" to the last question please state your reasons for this below.
   
 
 
 
Please describe the effect (if any) that your condition has had on your employment or ability to get employment?
   
Please describe the effect (if any) that your condition has had on your family life?