Benefits | QuestionPro

This is the questionnaire that deals with health care and your involvement in health care. Please take a few minutes to express your opinions about the availability and quality of health care in your community. Your answers are important to the success of this study.

Thank you for your assistance.

Which community (or rural area) do you live?

How many times have you and any member of your family been to your doctor in the last year?

How many times have you and other members of your family been a patient in a hospital in the last 3 years?

Which source of care would you prefer if you had a personal injury that could be handled equally well by each of these sources of health care:

I would prefer to go to a walk-in clinic

I would prefer to go to my personal physician

I would prefer to go to the hospital emergency room

Other

Sex of person completing this questionnaire:

Male

Female

Age of person completing this questionnaire:

Age(s) of children living in your household: (Check all that apply)

< 12

12 - 18

18+

Marital status of person completing this questionnaire:

Married

Widow(er)

Divorced or separated

Have never been married