Medical Decision-Making Assessment Form
Please complete this Medical Decision-Making Assessment Form to help us understand your approach and preferences in medical decision-making.
How confident do you feel in understanding the information provided about your medical condition or treatment?
*
Not at all confident
1
2
3
4
Extremely confident
5
1 is Not at all confident, 5 is Extremely confident
How often do you prefer to be involved in decisions about your medical care?
*
Always
Most of the time
Sometimes
Rarely
Never
Rate your comfort level with asking questions or expressing concerns during medical discussions.
*
1
2
3
4
5
How much do you feel your opinions are considered by medical professionals when making decisions?
*
Not at all
1
2
3
4
Completely
5
1 is Not at all, 5 is Completely
Who do you prefer to make final decisions about your medical care?
*
I prefer to decide myself
I prefer to decide together with my healthcare provider
I prefer my healthcare provider to decide after considering my views
I prefer my healthcare provider to decide without my input
Please indicate your agreement with the following statements about your participation in medical decisions.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel informed about my options.
1
2
3
4
5
I am encouraged to share my preferences.
6
7
8
9
10
My questions are answered clearly.
11
12
13
14
15
I participate as much as I want in decisions.
16
17
18
19
20
How easy is it for you to communicate your values and preferences to your healthcare provider?
*
Very Difficult
1
2
3
4
Very Easy
5
1 is Very Difficult, 5 is Very Easy
How satisfied are you with your current level of involvement in medical decision-making?
*
1
2
3
4
5
What, if anything, would help you feel more comfortable participating in medical decisions? (Optional)
Submit Assessment
Should be Empty: