Baseline NYS Advocacy Survey

1. Name (optional):

Name (optional):

2. County/borough where you live:

County/borough where you live:

3. 1. Do you know who your elected officials are?

1. Do you know who your elected officials are? Yes

If yes, who are they?

4. 2. Have you ever contacted any elected official about hepatitis B & C in the past?

2. Have you ever contacted any elected official about hepatitis B & C in the past? Never

Rarely

Frequently

5. Do you feel comfortable contacting your elected official by phone?

Do you feel comfortable contacting your elected official by phone? No

Somewhat

Completely

6. Do you feel comfortable contacting your elected official by email?

Do you feel comfortable contacting your elected official by email? No

Somewhat

Completely

7. Do you feel comfortable contacting your elected official by writing a letter or sending an email?

Do you feel comfortable contacting your elected official by writing a letter or sending an email? No

Somewhat

Completely

8. Do you feel comfortable contacting your elected official in person (at meetings, events or their office)?

Do you feel comfortable contacting your elected official in person (at meetings, events or their office)? No

Somewhat

Completely

9. Do you think contacting your elected official will have an effect on the decisions they make about Hepatitis B or C policies?

Do you think contacting your elected official will have an effect on the decisions they make about Hepatitis B or C policies? No

Maybe

Yes

Don’t know

10. Do you know what policies are currently being considered by your elected officials?

Do you know what policies are currently being considered by your elected officials? No

Yes

11. Do you feel that you are informed enough about Hepatitis B or C that you can communicate with your elected officials effectively?

Do you feel that you are informed enough about Hepatitis B or C that you can communicate with your elected officials effectively? No

Somewhat

Yes

12. Do you think the Hepatitis B & C related Policies need to be changed or improved in the United States?

Do you think the Hepatitis B & C related Policies need to be changed or improved in the United States? No

Yes

Not Sure

13. Are you interested in participating in a Legislative Awareness event?

Are you interested in participating in a Legislative Awareness event? Yes

Not Sure

14. Would you like to receive updates on hepatitis C policy and other hepatitis C legislative issues?

Would you like to receive updates on hepatitis C policy and other hepatitis C legislative issues? Yes

Not sure

15. I would you like to receive updates on hepatitis C policy
and other hepatitis C legislative issues, my email is:

I would you like to receive updates on hepatitis C policy and other hepatitis C legislative issues, my email is:

Baseline NYS Advocacy Survey
Exit this survey

1. Default Section

1. Name (optional):

2. County/borough where you live:

3. 1. Do you know who your elected officials are?

4. 2. Have you ever contacted any elected official about hepatitis B & C in the past?

5. Do you feel comfortable contacting your elected official by phone?

6. Do you feel comfortable contacting your elected official by email?

7. Do you feel comfortable contacting your elected official by writing a letter or sending an email?

8. Do you feel comfortable contacting your elected official in person (at meetings, events or their office)?

9. Do you think contacting your elected official will have an effect on the decisions they make about Hepatitis B or C policies?

10. Do you know what policies are currently being considered by your elected officials?

11. Do you feel that you are informed enough about Hepatitis B or C that you can communicate with your elected officials effectively?

12. Do you think the Hepatitis B & C related Policies need to be changed or improved in the United States?

13. Are you interested in participating in a Legislative Awareness event?

14. Would you like to receive updates on hepatitis C policy and other hepatitis C legislative issues?

15. I would you like to receive updates on hepatitis C policy
and other hepatitis C legislative issues, my email is:

Baseline NYS Advocacy SurveyExit this survey

1. Default Section

1. Name (optional):

2. County/borough where you live:

3. 1. Do you know who your elected officials are?

4. 2. Have you ever contacted any elected official about hepatitis B & C in the past?

5. Do you feel comfortable contacting your elected official by phone?

6. Do you feel comfortable contacting your elected official by email?

7. Do you feel comfortable contacting your elected official by writing a letter or sending an email?

8. Do you feel comfortable contacting your elected official in person (at meetings, events or their office)?

9. Do you think contacting your elected official will have an effect on the decisions they make about Hepatitis B or C policies?

10. Do you know what policies are currently being considered by your elected officials?

11. Do you feel that you are informed enough about Hepatitis B or C that you can communicate with your elected officials effectively?

12. Do you think the Hepatitis B & C related Policies need to be changed or improved in the United States?

13. Are you interested in participating in a Legislative Awareness event?

14. Would you like to receive updates on hepatitis C policy and other hepatitis C legislative issues?

15. I would you like to receive updates on hepatitis C policy and other hepatitis C legislative issues, my email is:

Baseline NYS Advocacy Survey
Exit this survey

15. I would you like to receive updates on hepatitis C policy
and other hepatitis C legislative issues, my email is: