healthcare | QuestionPro

The last section of the questionnaire contains a series of questions about your demographic characteristics such as age and income. We are asking these questions in order to determine if various groups have different opinions and attitudes about hospital care. Please answer these personal questions. No one will ever associate these responses with your name.

Sex of person completing this questionnaire:

Male

Female

Age of person completing this questionnaire:

Marital status of person completing this questionnaire:

Married

Widow(er)

Divorced or separated

Have never been married

What was your total household income (from all sources) before taxes for the year [Year]?

$25,000 or less

$25,000 - $49,999

$50,000 - $74,999

$75,000 - $99,999

$100,000 - $149,999

$150,000 and over

Please indicate the highest level of formal education that you have completed.

High school graduate

College graduate

Completed graduate school

PHD

Age of person completing this questionaire

18

18-22

23-27

above

The last section of the questionnaire contains a series of questions about your demographic characteristics such as age and income. We are asking these questions in order to determine if various groups have different opinions and attitudes about hospital care. Please answer these personal questions. No one will ever associate these responses with your name.