Hospital Access and Utilization

How often do you go to the hospital to see your doctor?

Weekly

Monthly

Annually

Only if there is an emergency

How would you rate your hospital experience when visiting your primary care physician?

Very Poor

Poor

Neutral

Fair

Excellent

What has prevented you mostly from arriving to your appointments?

Time of the appointment

Forgetting appointments

Public Transportation

Dependent on car service

How old are you?

	Drag your choices here to rank them
18-25 25-35 45-55 55-65 65-75 >75

Please indicate highest level of education completed:

	Drag your choices here to rank them
No Schooling Grade School High school College Post Grad

How interested would you be in a transportation service provided by the hospital prior to and/or completion of your appointment?