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Web Survey on Access to Health Care:
This Medical Web survey is from SurveyShare's library of web survey templates. It is contains questions about access to health care. It examines health care usage, location of services, and insurance coverage. You can work with this medical survey and put in on the Web! Just join the SurveyShare Web survey service. You can create a professional web based survey of your own with only a web browser. These example questions are free to you even if you decide not to use our web survey software, but we ask that you read this disclaimer:
Templates include suggested questions on a given topic. The survey templates have not been tested for validity and reliability. They are presented as survey design samples only. The questions are provided as possible examples of the type of questions you might want to include, without warranty for reliability or validity.

  Web survey service with a survey template library you cab access with jisy a Web broswer. SurveyShare is the best Internet tool for deploying surveys on the World Wide Web. Medical Web survey about Access to Health Care. Many other web survey templates in our web survey template resource. Use this mostly free Internet survey service to create a web survey with questions from a customizable web survey template like this Medical survey questionnaire.   Web survey service with a survey template library you cab access with jisy a Web broswer. SurveyShare is the best Internet tool for deploying surveys on the World Wide Web. Medical Web survey about Access to Health Care. Many other web survey templates in our web survey template resource. Use this mostly free Internet survey service to create a web survey with questions from a customizable web survey template like this Medical survey questionnaire.
   
1) Are you male or female?
2) What is your age?
3) Do you have health insurance?
Yes
No (go to question 5)
4) What type of health insurance coverage do you carry?
Employer provided
Self-purchased
Medicaid or State provided
Medicare
Other:
5) What is the MAIN reason you do not have health insurance?
Employer does not provide health insurance.
Can't afford to purchase health insurance.
Can't afford dependent coverage.
Other:
6) Do you receive routine physical examinations or health check-ups?
Yes (go to question 8)
No
7) What is the MAIN reason you do not receive regular physical examinations?
No insurance coverage
Insurance does not cover routine physical exams
Unable to afford co-pay
No time
No doctor
Not needed. I'm healthy
Other:
8) Do you have a family doctor or routine health care provider?
Yes (go to question 10)
No
9) Which of the following reasons apply for why you do not have a routine health care provider?
Never needed a doctor.
No HMO providers in my area.
No preferred providers in my area.
No insurance.
Don't like primary care physician assigned.
Other:
10) Where do you go when you need to see a doctor about a non-emergency health problem or illness?
Regular physician
Emergency Room
Urgent Care Clinic
Community Health Clinic
Other:
11) Please tell us the biggest obstacle you face for access to health care.
 
  Web survey service with a survey template library you cab access with jisy a Web broswer. SurveyShare is the best Internet tool for deploying surveys on the World Wide Web. Medical Web survey about Access to Health Care. Many other web survey templates in our web survey template resource. Use this mostly free Internet survey service to create a web survey with questions from a customizable web survey template like this Medical survey questionnaire.   Web survey service with a survey template library you cab access with jisy a Web broswer. SurveyShare is the best Internet tool for deploying surveys on the World Wide Web. Medical Web survey about Access to Health Care. Many other web survey templates in our web survey template resource. Use this mostly free Internet survey service to create a web survey with questions from a customizable web survey template like this Medical survey questionnaire.
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