Transgender, Non-Binary and Intersex Mental Health Survey
Thank you for taking the time to complete our survey. This shouldn't take you more than 20 minutes.

If you'd like to be entered in the $100 drawing (5 possible prizes), make sure to enter your email down below.

This survey is a collaboration between Jake R Consulting, and the Los Angeles County Department of Mental Health's LGBTQIA2-S UsCC Subcommittee.

As non-binary and intersex identities are becoming more visible and understood by the public, there remains very little data and research around mental health and related issues/challenges regarding non-binary and intersex people. The objective of the Non-Binary & Intersex Mental Health Survey is to promote mental health services, reduce stigma and barriers to mental health services for the non-binary and intersex communities, and increase the capacity of the public mental health system in Los Angeles County.

For questions, please contact: jake@lgbtaffirmative.com


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Instructions and Information
- Please only fill this survey out once. If you make a mistake, let us know and we will delete the entry and you can fill it out again.
- Questions around demographics are open ended, but required. This information will only be utilized for report purposes.

For 24/7 mental health help, please call the Department of Mental Health Helpline: (800) 854-7771

If you need urgent or life saving mental or medical health assistance during this survey please stop immediately and call 911.

LEGEND:
DMH: Department of Mental Health
NBI: Non-Binary and Intersex
LAC: Los Angeles County
In order to offer the ability to track responses anonymously, we are giving the option for you to create a personalized pin. Please enter your four favorite numbers and today's date. For example, if my four favorite numbers were 1234 and today's date was January 1st, it would look like: 12340101. Please keep this number safe in case you need to reference your survey. *
If you would like to be entered in our $100 gift card drawing, please provide your email as well. We will not reach out to you except to provide information about survey results. *This is not required*
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