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Health Needs Assessment

Thank you for doing this survey. This survey asks questions about you and some factors that may affect your health. This information will help the Massachusetts Behavioral Health Partnership (MBHP) better understand your needs and we can use it to identify resources that may be helpful to you. Your responses are confidential and will be not used for any other purposes than finding ways that MBHP can support you.

The survey will take around 20 minutes to complete. If possible, try to complete it in one sitting. If you cannot, the questions that you have submitted will be saved and you can log in later to finish the remaining questions.

If you need help completing the survey, please call 1-800-495-0086.

Member Name:
Last
 
First
 
Middle

 
Member date of birth:

 
Member street address:
Address line 1
 
Address line 2

 
Member city
 
Member State
 
Member Zip Code
 
 
Member Phone Number

MassHealth Member ID

Enter MassHealth Member ID or select the checkbox below.
 
I don’t know my MassHealth Member ID