Healthcare Experiences: CAIR Survey

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Thank you for taking the time to respond to this short survey!

You name and contact info is optional. We will not distribute this information to anyone outside of CAIR-Philadelphia, but may use it to follow up with you about your answers.

Please submit all responses by August 30, 2014.

Where do you live? *

Name (OPTIONAL):

E-mail (OPTIONAL):

Have you ever experienced any cultural or religious issues in your interactions with the medical field or with healthcare professionals? If so, please describe below:

Have you or anyone you know ever experienced any problems with end of life care? If so, please describe below:

Have you or anyone you know ever experienced any problems with regards to autopsies? If so, please describe below:

How knowledgeable are you about the United States healthcare system, including health insurance, Medicare/Medicaid, what kind of provider to see for regular care versus emergency care, etc.? *

(Rate your knowledge on a scale from 1-5, with 5 being the most knowledgeable)

1 (not very knowledgeable)

5 (very knowledgeable)

Prefer not to answer

Do you currently have healthcare insurance? *

Yes

Prefer not to answer

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