Exit this survey >>
Survey About Your Experience Filling Out The Standard Health Questionnaire October 2009 Version
*
1
. Overall, how much of a problem did you have in understanding the directions and instructions on the Standard Health Questionnaire? Choose one answer below.
Overall, how much of a problem did you have in understanding the directions and instructions on the Standard Health Questionnaire? Choose one answer below.
A big problem
A small problem
Not a problem
I do not know
*
2
. Overall, how much of a problem did you have in understanding the items (health/medical conditions) on the Standard Health Questionnaire? Choose one answer below.
Overall, how much of a problem did you have in understanding the items (health/medical conditions) on the Standard Health Questionnaire? Choose one answer below.
A big problem
A small problem
Not a problem
I do not know
*
3
. Overall, how much of a problem did you have in understanding how to fill in the appropriate circles (choosing your answers) if you indicated that you had a medical condition? Choose one answer below.
Overall, how much of a problem did you have in understanding how to fill in the appropriate circles (choosing your answers) if you indicated that you had a medical condition? Choose one answer below.
A big problem
A small problem
Not a problem
I did not select any medical conditions, so I did not have to fill in any circles
*
4
. Would you make any changes to the Health Questionnaire to improve the experience of other people in filling out the Standard Health Questionnaire? Choose one answer below.
Would you make any changes to the Health Questionnaire to improve the experience of other people in filling out the Standard Health Questionnaire? Choose one answer below.
Yes, definitely
Yes, maybe
No, the SHQ is fine the way it is
I do not know
*
5
. Overall, on a scale from 1 to 10 how would you rate your experience in filling out the Standard Health Questionnaire? Please fill in your choice from 1 to 10 below.
1
2
3
4
5
6
7
8
9
10
1 Being Extremely Easy and 10 being Extemely Difficult
*
Overall, on a scale from 1 to 10 how would you rate your experience in filling out the Standard Health Questionnaire? Please fill in your choice from 1 to 10 below. 1 Being Extremely Easy and 10 being Extemely Difficult 1
1 Being Extremely Easy and 10 being Extemely Difficult 2
1 Being Extremely Easy and 10 being Extemely Difficult 3
1 Being Extremely Easy and 10 being Extemely Difficult 4
1 Being Extremely Easy and 10 being Extemely Difficult 5
1 Being Extremely Easy and 10 being Extemely Difficult 6
1 Being Extremely Easy and 10 being Extemely Difficult 7
1 Being Extremely Easy and 10 being Extemely Difficult 8
1 Being Extremely Easy and 10 being Extemely Difficult 9
1 Being Extremely Easy and 10 being Extemely Difficult 10
*
6
. Lastly, if you wanted to improve the Standard Health Questionnaire, please tell us the most important aspect of the questionnaire you would change in the space provided. If you would not change anything, please indicate this and your reason(s) why.
Lastly, if you wanted to improve the Standard Health Questionnaire, please tell us the most important aspect of the questionnaire you would change in the space provided. If you would not change anything, please indicate this and your reason(s) why.
Javascript is required for this site to function, please enable.