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  2. 2010
  3. October
  4. M
  5. MMG 11-end
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How many times have you changed your Family Doctor within the past 5 years?
 
0
 
1
 
2
 
3
 
4 or more times
 
 
 
How far are you willing to drive/travel to visit your Family Doctor?
 
0-5 miles
 
6-10 miles
 
11-15 miles
 
16-20 miles
 
20 or more miles
 
 
 
How likely are you to change your current Family Doctor at this point in time?
 
Unlikely
 
Somewhat Unlikely
 
Likely
 
Somewhat Likely
 
Very Likely
 
 
 
Comments:
   
 
 
Demographic Information
Gender
 
Male
 
Female
 
 
 
To which ethnic group do you most identify with?
 
African-American (Non-Hispanic)
 
Caucasian (Non Hispanic)
 
Asian/Pacific Islanders
 
Latino or Hispanic
 
Other
 
 
 
What is the highest level of education you've had the oppportunity to complete?
 
High School
 
Some College
 
Bachelors Degree
 
Masters Degree
 
Post Graduate Degree
 
Other
 
 
 
What is your current marital status?
 
Single
 
Married
 
Widowed
 
Divorced
 
Separated
 
 
 
What is your total household income?
 
Less than $40,000
 
$41,000 - $60,000
 
$61,000 - $80,000
 
$81,000 - $100,000
 
$101,000 or greater
 
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