Healthcare insecurity in NJ
Hello! I am a college student and NJ resident conducting a survey regarding healthcare insecurity to perform a spatial analysis on healthcare deserts in the state.  Thank you for taking the time to fill out this survey!
Log in bij Google om je voortgang op te slaan. Meer informatie
I am a NJ resident (if you are not a NJ resident, please do not fill out this survey!) *
I have health insurance  *
For those WITH health insurance: 
Has the cost of health insurance (copays, deductibles, etc.) caused you to forego seeking healthcare? 
Selectie wissen
For those WITHOUT health insurance: 
Has the cost of healthcare caused you to forego seeking care? 
Selectie wissen
I have experienced primary care provider shortages and/or have been unable to see a provider due to lack of insurance coverage or other unavailability. *
If your household income is BELOW the median (~$96,346/year), have you experienced frequent lack of healthcare access due to insurance difficulties and/or cost?  
Selectie wissen
If your household income is ABOVE the median (~$96,346/year), have you experienced frequent lack of healthcare access due to insurance difficulties and/or cost?  
Selectie wissen
If your household income is BELOW the median (~$96,346/year), have you experienced a severe injury and/or chronic illness worsened or caused by a lack of healthcare access?
Selectie wissen
If your household income is ABOVE the median (~$96,346/year), have you experienced a severe injury and/or chronic illness worsened or caused by a lack of healthcare access?
Selectie wissen
For those whose household income is BELOW the median (~$96,346/year), how close is your nearest hospital?
Selectie wissen
For those whose household income is ABOVE the median (~$96,346/year), how close is your nearest hospital?
Selectie wissen
What is your age group?
Selectie wissen
THANK YOU!
Verzenden
Formulier wissen
Verzend nooit wachtwoorden via Google Formulieren.
Dit formulier is gemaakt in Cornell. Misbruik rapporteren