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Surveys
2016
May
P
ProvidenceEnglish
ProvidenceEnglish
0%
Exit Survey
Welcome to the Providence 2016 Cinco de Mayo Survey
What is your age?
18-24
25-31
32-38
39-45
46-52
52-59
60+
What is your gender?
Male
Female
What is your ethnicity? (Select all that apply)
American Indian or Alaska Native
Asian
Black/African American
Hispanic/Latino
Middle Eastern or Indian
Native Hawaiian or Pacific Islander
White/Caucasian
Other
What's the highest level of education you have achieved?
Elementary School
Middle School
High School
Some College
Bachelor's Degree
Masters or higher
Other
What is your household's annual income?
Less than $15,000
$15,001-$25,000
$25,001-$35,000
$35,001-$50,000
$50,001-$75,000
More than $75,000
What is your area of occupation?
Homemaker
Student
Government
Construction
Food or Service Industry
Retail, Sales or Marketing
Healthcare or Technology
Business Owner
Agriculture
Retired
Unemployed
Nonprofit or Education
Other
Do you have health insurance?
Yes
No
Do your kids have health insurance?
Yes
No
I don't have kids
In thinking about what matters when selecting a health care provider or caregiver, to what extent are the following issues important? Please select your response for each item.
Not at all
Rarely
Somewhat
Very Much
Distance from home or work
Hours that care is available
Relationship with provider or care team
Out of pocket cost
Recommendations from friends, family or trusted sources
The provider or care team speaks my language
The provider or care team is knowledgeable of my culture
Issues of privacy or confidentiality
Services and information are available in my language
In thinking about what matters when choosing a health insurance plan, to what extent do the following factors matter? Please select your response for each item.
Not at all
Rarely
Somewhat
Very Much
Familiarity with name or brand
Brand or provider is active or is supportive of my community
Agents and staff reflect the diversity of my community
Out of pocket costs
Recommendations from friends, family or trusted sources
The provider or care team speaks my language
The provider or care team is knowledgeable of my culture
Range of benefits
Number of providers in my area
Services and information are available in my language
Thank you for your participation! Please complete the survey by pressing "Next"
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