Wellness Made Easy

Wellness Made Easy

Community Member Survey

Please answer as many questions as you feel comfortable with, as this information helps us help you.

    1. How confident are you filling out medical forms by yourself?

    Very confidentSomewhat confidentNot confident

    2. How often do you have difficulty understanding written medical information?

    AlwaysSometimesNever

    3. Do you feel understood by healthcare professionals?

    AlwaysSometimesNever

    4. Do you feel supported by healthcare professionals?

    AlwaysSometimesNever

    5. How do you get to doctor appointments?

    My own carThe public busesI walkI ride a bikeI use a taxiA friend or family member takes meI don't have transportation, thus it is very difficult to get to appointments

    6. Do you have childcare or a family/friend to take care of your child/children when you need to go to a doctor’s appointment?
    YesNoSometimesDoes not apply

    7. When you are sick, do you seek healthcare immediately?
    YesNo, I wait until my symptoms get worseNo, I wait until I am very sick

    8. When you are sick, where do you usually go to get help?
    My primary care doctorAn urgent care centerThe emergency room at the hospital

    9. Are you able to afford your medications?
    YesNoSometimes

    10. Do you understand the instructions on your medication bottle?
    YesNoSometimesI have to ask someone else to read it and explain it to me

    11. Do you have any type of health insurance? (for example: private, medicare, medicaid, VA benefits)
    YesNo

    12. Are you living:
    AloneWith other people/family in a rented or owned homeIn a residential facilityWith a relative or friend temporarilyIn a shelter

    13. Of the list below, what is the most important to you?
    Increasing my incomeImproving my housingFinding healthcare when I need itStaying healthy so that I don't need healthcareBeing able to afford enough food for myself and/or my family

    14. Do you have either family or friends to help you manage your health?
    YesNoPeriodically

    15. In the past 3 months, have you had trouble paying for necessary expenses? If other, please specify below.
    NoFoodHousingElectricityMedical ExpensesTransportationChildcareOther:

    16. Would you be likely to use an app on your smartphone to access health information?
    YesNoI do not have a smartphone

    17. Have you used the Wagner Wellness Van?
    YesNoI want to but don't know howI don't know what the Wagner Wellness Van is

    18. In which county do you live?
    DorchesterSomersetWicomicoWorcesterOther:

    If you would like to enter into a drawing for a $25 Food Lion gift card, please provide your contact information. Your contact information will not be shared. Your anonymous survey responses will help us develop practical tools to help our community improve access to health information to achieve optimal health. Your answers will not be associated with your contact information but compiled in aggregate data with all respondents to this survey.

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