Women's Health Survey

Women's Health Survey

2023
Thank you for making time to provide insight on your health and wellbeing. We appreciate your input. If you have questions about the survey, email QMed-Marketing@quadmedical.com.
Please indicate if you are:
Please select your age range.
How would you rate your physical health?

1

2

3

4

5

1 is Poor, 5 is Excellent
How would you rate your mental health?

1

2

3

4

5

1 is Poor, 5 is Excellent
Do you use the health center?
If no, what are the reasons you have not used the health center? Check all that apply.

Other
If so, how often do you use the health center?
If yes, do you consider QuadMed health center your medical home? (A medcial home is a model of care where patients have a direct relationship with a provider who coordinates a medical team focused on your health care.)
If yes, how has your experience been?

1

2

3

4

5

1 is Poor, 5 is Excellent
What reasons do you seek healthcare? Check all that apply.
Please check topics you are interested in learning more about. Check all that apply.

Other
Please share how we can improve.
On a scale of 1 to 5, how likely are you to recommend QuadMed to others?

1

2

3

4

5

1 is Least likely, 5 is Most likely
If you chose a 3 or below, please tell us why.
Should be Empty: