LYSIS USER QUESTIONNAIRE

Name

Age

Area

Friends

Information read


Outness

        mother
        father
        siblings
        friends
        others

Method of contact

a. letter

b. telephone

Information sent

a. booklet
b. pack
c. local contacts
d. further, relevant, information

Pen-pal


Referral


On-going

a. telephone

b. correspondence

Advocacy

Coming Out


LYSIS member

Evaluation form: help received good/bad; met needs?

Specific Problems

Six-monthly check up