Family Health Decisions Survey
Share how your family approaches health-related decisions, what factors matter most, and whether you want any follow-up.
Family Decision Context
Your role in the household or family
*
Parent/Guardian
Spouse/Partner
Adult child
Other family member
Other
Number of family members involved in health decisions
*
Primary health decision area being discussed
*
Please Select
Routine care
Specialist visits
Medication choices
Preventive care
Long-term care
Other
Decision-Making Preferences
Who usually makes the final health decision in your family?
*
I decide
Partner decides
Decided together
Other family member decides
Shared by everyone
Other
How are health decisions typically discussed in your family?
*
Please Select
Open discussion with everyone
Discussed by a few key people
One person listens and decides
Mostly decided individually
Depends on the situation
Other
How confident do you feel in shared decision-making?
*
Not at all confident
1
2
3
4
Very confident
5
1 is Not at all confident, 5 is Very confident
Influences and Priorities
How important are the following factors when your family makes health decisions?
*
Rows
Not important
Slightly important
Moderately important
Very important
Extremely important
Cost
1
2
3
4
5
Convenience
6
7
8
9
10
Doctor recommendations
11
12
13
14
15
Comfort
16
17
18
19
20
Timing
21
22
23
24
25
Impact on daily routines
26
27
28
29
30
Which factor is the top priority in most family health decisions?
*
Please Select
Cost
Convenience
Doctor recommendations
Comfort
Timing
Impact on daily routines
Other
Follow-up Preferences
Preferred next step after the survey
*
Follow-up discussion
No follow-up needed
Decide later
Preferred contact method for follow-up
Email
Phone
No follow-up
Additional comments or concerns
Submit
Should be Empty: