1. Basic information

Full name

Preferred name (optional)

Pronouns (optional)

Phone

Preferred method of contact

Phone
Text
Email

Emergency contact name

Emergency contact number

2. Background and demographics

Date of birth

Age (if you’d rather not give a date)

Languages spoken

Do you have any cultural, religious, or personal preferences you would like your peer supporter to be mindful of?

3. Current well-being and support

What brings you to peer support today?*

What are your main goals or hopes for our time working together?

Current support system
Who or what currently helps you when you are struggling? For example family, friends, specific hobbies, therapy, or support groups.

What kinds of coping strategies work best for you?

4. Preferences and boundaries

What type of support do you find most helpful?

Choose any that fit, and add anything else below.

Active listening
Brainstorming solutions
Sharing shared experiences
Gentle accountability

Anything else about how you like to be supported (optional)

Are there any triggers, topics, or communication styles you prefer to avoid?

How often would you like to connect?

Preferred format

In person
Phone
Video call

Anything else about meeting times or format? (optional)

Peer Support Questionnaire

1. Basic information

2. Background and demographics

3. Current well-being and support

4. Preferences and boundaries

5. Review your answers, then download a copy to share with your peer supporter

Blog Topics

Subscribe to receive the latest news from GUIDE!

Recent Posts