Survey on healthcare
This survey should take no longer than 15 or 20 minutes to complete. Your participation in this survey is voluntary. You may exit the survey at any time without penalty. You are free to refuse to answer any particular question you do not wish to answer for any reason. You will receive no direct benefits from participating in this study. However, your responses will help us learn more about the impacts of the Affordable Care Act and identify our members' concerns regarding healthcare.
Some of the survey questions may be distressing to you as you think about your experiences.
Your responses will remain anonymous. No one will be able to identify you or your answers, and no one will know whether or not you participated in the study.
At the end of the survey you will be asked if you are interested in participating in an additional phone interview. If you choose to provide contact information such as your phone number or email address, your survey responses may no longer be anonymous to the researcher. However, no names or identifying information would be included in any publications or presentations based on these data, and your responses to this survey will remain confidential.
If you have questions at any time about the study or the procedures, you may contact Armelle Denis at
. Thank you!
Informed consent: please click the box below if you agree to take this survey.
I read the information above, I am 18 years of age or older, and I voluntarily agree to take this survey.
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This form was created inside of RISE Partnership.