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  1. Surveys
  2. 2013
  3. March
  4. P
  5. Practice Women Veteran Survey
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Exit Survey
 
 
1. How do you describe your military status? (Please check all that apply)
 
I am an active service member
 
I am a veteran
 
I am a reservist
 
Other (Please Specify)
 

 
 
 
3. How long did you serve/have you served in the military? (Please check one)
 
Less than 2 years
 
2-4 years
 
4-6 years
 
6-10 years
 
Over 10 years
 
 
 
5. What was your rank upon separation?
   
 
 
 
12. What county do you live in?
 
 
18. For the following Federal VA benefits, please mark whether you have received or claimed each one and, if no, why not?
I have used this benefit I did not know about this benefit I knew about this benefit but had challenges in receiving it I knew about this benefit but I did not think I qualified for it I knew about this benefit but I did not need to use it
Disability
Educational or Vocational
Employment Services
Home Loan
Medical or Dental
Mental Health Services
Readjustment Counseling
Other (Please specify below)
 
 
19. When you have a question about your Federal VA benefits, what way(s) would you most prefer to access answers and help? Please rate the following means of communicating this information using the following scale:
Not Useful Somewhat Useful Very Useful
Toll-free Telephone Number
Email
Facebook, Twitter, Mobile Apps, etc.
Informational Website
Printed Materials/Claim Forms mailed to you
In-Person Consultation (for example, talking to someone at the CALVET or other veteran service organizations)
 
 
33. If you sought treatment for this trauma, how long after the first incident did you seek treatment
and where?
How long After?
Where?
 
 
Contact Information
Name
Address
City
State
Zip
Email Address
Phone Number