* 1. Have you or a member of your family ever experienced medical harm?

* 2. Have you ever filed a complaint with your state medical board?

* 3. If you filed a complaint with a state medical board, how do you describe your experience?

* 4. How would you rate your state medical board's response and investigation to your complaint? (Suggested answers: "Poor", "Fair", "Excellent", "No opinion")

* 5. Was your complaint investigated or closed without an investigation?

* 6. Were you satisfied with the outcome of your complaint?

* 7. Did the board take any disciplinary action against the provider as a result of your complaint?

* 8. Please list your top three concerns as to why you were dissatisfied with your state medical board's investigation.

* 9. In which state do you live? Please fill out your name and/or email address if you wish to do so. This information will not be public. Those who wish to remain anonymous can still do so by filling out just the state information.

* 10. What improvements are necessary for state medical board to protect the public?

T