Cedar Park Readership Survey
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1. Readership Survey

We appreciate your opinion and we want to communicate with you in a way that fits your lifestyle.
We are considering "Going Green" and creating an online publication. Please let us know if you would like to receive our Health Connection newsletter via traditional mail, or if you would prefer to read it online with email notification of each new issue.

Questions with an "*" indicate that we need all information filled out in that particular category.

1. Please provide us with the following information so we can ensure you are recieving the type of communication that best suits you:

Please provide us with the following information so we can ensure you are recieving the type of communication that best suits you: Name:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Email Address:
Phone Number:

2. What is your Date of Birth?

	MM		DD		YYYY
Please Enter Month/Date/Year	What is your Date of Birth? Please Enter Month/Date/Year Month	/	Day	/	Year

3. How would you prefer to read Health Connection...

How would you prefer to read Health Connection... Have it available to read online with email notification of each new issue

Recieve a printed magazine through traditional mail services

4. Have you or your immediate family come to Cedar Park Regional Medical Center for any type of service? If so, which one(s)?

Have you or your immediate family come to Cedar Park Regional Medical Center for any type of service? If so, which one(s)? Emergency Care X-Ray/MRI/CT (Imaging Services) Surgical Care Cardiac/Pulmonary Care	Orthopedic Care Critical Care Women's Services Laboratory Services
Other (please specify)

5. What type of topics or subjects would you like to see covered in Health Connection?

What type of topics or subjects would you like to see covered in Health Connection?

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Cedar Park Readership SurveyExit this survey

1. Readership Survey

Cedar Park Readership Survey
Exit this survey