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Surveys
2013
March
H
HEALTH SURVEY
HEALTH SURVEY
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Hello:
You are invited to participate in our survey [HEALTH SURVEY]. In this survey, approximately 500 people will be asked to complete a survey that asks questions about family details and related health issues. It will take approximately two-three minutes to complete the questionnaire.
Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.
Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Bharath Niranjan at 919833623975 or by email at
[email protected]
Thank you very much for your time and support. Please start with the survey now by clicking on the
Continue
button below.
Total family members
One
Two
Three
Above Three
Family Member above 50 years of age and below 10 years of age
One
Two
Three
Above Three
Which category best defines your annual income?
2.5 to 5.0 Lakhs
5.0 to 7.5 Lakhs
7.5 to 10.0 Lakhs
Above 10 Lakhs
Frequency of hospital visits in a month
Once
Twice
Thrice
More than three times
Have you or your family members felt the need for professional medical help immedialtely?
Yes
No
In case of emergency,would you prefer medical assistance in the first
Five Minutes
Fifteen Minutes
More than fifteen minutes
Which of the following categories best describes the industry you work in?
Automotive
Advertising
Consulting Services
Education
Entertainment
Financial Services
Government Services
Healthcare
Human Resources
Information Technology
Marketing/Sales
Non-Profit
Pharmaceuticals
Public Relations
Technical Services
Travel
Other
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