PATIENT'S SURVEY
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.
What is your e-mail address?
(Required)
Is this your first visit to
MEDPRICE.COM
or is this a return visit?
1st visit
2nd visit
3 or more visits
What is your main reason for visitng or using
MEDPRICE.COM
?
Personal needs
Spousal needs
Child needs
Friend's needs
Research
Other
What is your gender?
Female
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What is your age?
18-25
26-35
36-45
46-55
56-65
Over 65
In your opinion, is
MEDPRICE.COM
a user friendly site?
Very friendly
Friendly
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Do you find the
MEDPRICE.COM
process is helpful for your needs?
Very helpful
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What is your highest level of education completed?
Highschool
Highschool Equivalency
Associates Degree
College 4-year Degree
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Other School
What is your profession?
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accountant
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actor
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announcer
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driver
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employee
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priest
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sexton
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striptease artiste
student
surgeon
tailor
tax consultant
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teacher
technician
train dispatcher
translator
transport supervisor
tutor
unemployed
veterinary surgeon
waiter
warden
webmaster
worker
writer
Additional_Comments:
Thank you for your time and consideration.
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