Hospital Questionnaire
Please answer the following questions, to help us understand the needs of the community.
Email address *
In the last 5 years, how many times have you or a member of your family been admitted for an overnight stay in the hospital *
1 point
Required
In the last 5 years, how many times have you or a member of your family visited an Emergency Room? *
1 point
Required
In the last 5 years, how many times have you or a member of your family visited an Urgent Care Clinic? *
Required
In the last 5 years, how many times have you or a member of your family visited Care Regional Medical Center as a patient? *
Required
If a hospital were built in San Patricio County, where should it be located? (choose as many as you like)
If a hospital were built in San Patricio County, who would you prefer to administer the hospital? (choose as many as you like)
Age Demographic
Healthcare Insurance (Circle all that apply)
Number of people living in your house or apartment including yourself
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of HELP Disaster Management. Report Abuse - Terms of Service - Additional Terms