Your Name
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Your Email
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Phone Number
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Ohio County You Live In
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Montgomery
Greene
Clark
Champaign
Miami
Preble
Butler
Warren
Clinton
Shelby
Logan
Darke
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Are you, or were you ever, employed as a Defender of the U.S. Constitution in the capacity of a United States Service Member (Air Force, Army, Coast Guard, Marines, Navy); or First Responder (EMS, Firefighter, Police).
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Yes
No
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Are you diagnosed with Post-traumatic Stress Disorder (PTSD), think you might have Post-traumatic Stress Injuries (PTSI), or other psychological health condition(s) (e.g. Depression, Anxiety, etc.) as a result of your time in service?
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Yes
No
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Are you receiving treatment for PTSD or other psychological health condition as a result of your time in service?
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Yes, I am currently receiving treatment for PTSD
No, I am not yet in treatment for PTSD
No, but I think I would benefit from treatment for PTSD
I have completed treatment for PTSD
Never occurred to me
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What are you most curious to explore?
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Art
Music
Writing
Yoga
Open to anything
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