We are interested in learning more about access to medical care. Please take a few minutes to answer the short survey below.
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Personal Info:
Name:
City:
State:
Country:
Age: (optional)
Job Title:
Email:
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Survey:
1. How many medical facilities does your town/county have?
None 1 2 More than 2
2. How many practicing physicians does your medical facility employ?
None 2-5 6-10 11-20 More than 20
3. How many nurses does your medical facility employ?
None 2-5 6-0 11-20 More than 20
4. How many pharmacies does your town/county have?
None 1 2 3 More than 3
5. Does your town have a mobile emergency medical unit?
Yes No Other
6. What level of training does a physician receive? Select all that apply.
Non-medical University (Bachelors) degree Advanced University (Masters) degree 4 year Doctorate Doctorate plus training (Residency) Other
7. What level of training does a nurse receive?
1 year of schooling 2 years of schooling 3 years of schooling 4 years of schooling Other
8. Other than nurses and doctors what types of medical personnel does your medical facility employ? Please choose all that apply.
Physician assistants Nurse Practitioners Medical Directors Medical Aids or Assistants Other
9. What resources do you have for addressing extremely challenging medical questions?
Books and other research materials Network of medical personnel Internet Access Other medical facility to refer patient None
10. How often have you been declined prescription drugs for any of your family members (including You, Spouse/Partner and/or Children)?
Books and other research materials Internet Seminars Multi-day conferences University courses
11. What salary do you receive yearly?
Less than $5,000 $5,001-$10,000 $10,001-$25,000 $25,001-$50,000 $50,001-$75,000 $75,001-$100,000 More than $100,000
12. Are all of your necessary supplies and equipment readily available to you?
Never Rarely Sometimes Often Always
13. Are necessary supplies and equipment functional?
14. What types of illnesses do you treat? Please choose all that apply.
Infectious disease Trauma General health problems Terminal illnesses Obstetric complications General aging problems Surgery
15. Overall how would you describe your access to resources to provide adequate medical care?
Excellent Very good Good Fair Poor
