Access to Health Care

The following survey will ask for your personal information (Age, gender, etc) for the sole purpose of data collection and analysis. Your personal information will not be shared or distributed. Your name will only be used if you choose to, otherwise all information will remain anonymous. At the end of this survey, you will have the choice to mark all your responses as anonymous, or to use your name for only the responses you have chosen to answer.

Age

Gender

Male

Female

What city/town do you currently live in?

Province/Territory

Employment Status

Employed full time

Employed part time

Seasonal/Contract work

Unemployed

Marital Status

Single

Common law

Married

Education Level

Do you identify as First Nations?

Yes

No

Do you currently have status (Registered in the Indian Register)

Yes

No