Patient Education Needs Survey Form
Please complete this survey to help us understand your education needs and preferences. Your responses will guide us in providing better resources and support.
Which age group do you belong to?
*
Please Select
Under 18
18–29
30–44
45–59
60 and above
What is your preferred way to receive health information?
*
Printed materials (brochures, handouts)
Videos
One-on-one sessions
Group classes
Online articles/resources
Other
Which health topics are you most interested in learning about? (Select all that apply)
*
Nutrition and healthy eating
Physical activity
Managing chronic conditions
Medication management
Mental health and stress
Preventive screenings
Other
How confident do you feel about your current knowledge of your health condition(s)?
*
1
2
3
4
5
How likely are you to use digital resources (such as websites or apps) for learning about health topics?
*
Not likely
1
2
3
4
Very likely
5
1 is Not likely, 5 is Very likely
What are the biggest barriers you face in learning about your health? (Select all that apply)
*
Lack of time
Difficult to understand materials
Limited access to resources
Not sure what is trustworthy
Language barriers
Other
How do you prefer to ask questions or get support about your health?
*
In person
By phone
By email
Through a patient portal
Other
Please rate how helpful you find each of the following education methods.
*
Rows
Not helpful
Somewhat helpful
Very helpful
Printed materials
1
2
3
Videos
4
5
6
One-on-one sessions
7
8
9
Group classes
10
11
12
Online resources
13
14
15
Would you be interested in attending future educational sessions?
*
Yes
No
Maybe
Please share any comments or suggestions about how we can improve patient education.
Submit Survey
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