Community Health Treatment Selection Survey
Help us understand your treatment preferences and experiences to improve community health services.
Full Name
*
First Name
Last Name
Age
*
Gender
*
Male
Female
Non-binary
Prefer not to say
What is your current health status?
*
Excellent
Good
Fair
Poor
Which types of health treatments have you used in the past year? (Select all that apply)
*
Primary care (doctor visits)
Specialist care
Traditional/alternative medicine
Emergency care
Telemedicine/virtual care
None
Other
How do you usually choose your health treatment provider?
*
Recommendation from family/friends
Online reviews
Insurance network
Proximity/location
Referral from another provider
Other
Please rate your satisfaction with the following aspects of community health treatments:
*
Rows
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Availability of services
1
2
3
4
5
Quality of care
6
7
8
9
10
Communication with providers
11
12
13
14
15
Accessibility (transport, cost, etc.)
16
17
18
19
20
How important are the following factors when selecting a treatment?
*
Not Important
1
2
3
4
Very Important
5
1 is Not Important, 5 is Very Important
How would you rate your overall experience with community health treatments?
*
1
2
3
4
5
What challenges have you faced when seeking health treatment in your community?
Do you have any suggestions to improve community health treatments?
Submit Survey
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