Next For Me: Healthcare Survey 2019
Thank you for being part of the Next For Me community! We would love to learn more about what’s Next for You and the topics that are important to you.This time we're talking about healthcare.

Your answers are completely confidential and we won’t ever share or sell your contact information.

Participants will receive a Next For Me Sticker Pack! One survey respondent will win a gift bag from Cordial Organics.

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What is your age?   *
What is your gender?   *
What is your relationship status?   *
What is your level of education?   *
Where do you live? *
Which of these best describes your employment status? *
What type of healthcare coverage do you have? *
Are you satisfied with your current healthcare coverage? *
If you are satisfied with your healthcare coverage, what do you like about it? *
Required
If you aren’t satisfied with your healthcare coverage, what don’t you like about it? *
Required
Which of these statements best describes your healthcare planning with Medicare? *
How true is this statement? I will delay retirement in order to save more money for healthcare costs. *
How true is this statement? I have stayed or will stay in a job in order to keep healthcare benefits. *
Are you currently a caregiver to a parent or loved one who is unable to work? (Caregiving includes, but is not limited to, full time in-home care, managing finances, transporting to/from appointments, running errands) *
How did you first hear about Next for Me? *
If you would be interested in being interviewed about these topics please provide your email below.
If you'd like to receive a Next For Me Sticker Pack for participating, please provide your mailing address. We won’t ever share or sell your contact information. If you'd like to be entered into a drawing to win a gift bag from Cordial Organics leave your email address.
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