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Getting Started

The information you share here will not be shared with others in Q Chat Space or beyond.

Your email address Check here if you want to receive weekly emails about upcoming chat schedules and updates.
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:

Where did you hear about Q Chat Space? (Select one)

OtherSource

By checking this box, you understand that:

Q Chat Space facilitators are not medical or mental health professionals and cannot provide crisis intervention. Q Chat Space facilitators may also be required by state law to report information shared in the chat if you share that you are being abused (physically, sexually, or emotionally) or that you want to hurt yourself or someone else.

We are always working to make Q Chat Space as helpful as possible for the people who use it. We are asking the questions below and will ask them again in optional surveys available after chatting so that we can figure out how to improve Q Chat Space.

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:

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:

In the past month, please describe how often…

I have someone who will listen to me when I need to talk.

Never
Rarely
Sometimes
Usually
Always

I have someone to confide in or talk to about myself or my problems.

Never
Rarely
Sometimes
Usually
Always

I have someone who makes me feel appreciated.

Never
Rarely
Sometimes
Usually
Always

I have someone to talk with when I have a bad day.

Never
Rarely
Sometimes
Usually
Always

Over the last two weeks, how often have you been bothered by the following problems?

Little interest or pleasure in doing things

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

Feeling down, depressed, or hopeless

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

Feeling nervous, anxious, or on edge

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

Not being able to stop or control worrying

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

The next questions are about your experiences as a member of the LGBTQ community.

I am proud to be a part of the LGBTQ+ community

Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree

I feel pride in being an LGBTQ+ person

Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree

I feel I am part of the LGBTQ+ community.

Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree

Participating in the LGBTQ+ community is a positive thing for me.

Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree

I feel a bond with the LGBTQ+ community.

Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree

I am proud of the LGBTQ+ community.

Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree

Thank you!

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