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Illinois Chapter, American Academy of Pediatrics (ICAAP) Adolescent Health Survey

1.Introduction

The goal of this survey is to identify adolescent/young-adult knowledge and understanding of the following health topics and services:

· Annual Check-Up (also known as health supervision visit, annual check-up, well adolescent visit, preventive health care visit)
· Doctor or Healthcare Provider’s Office
o Appointments
o Topics
·Social Media Usage
·Patient Portal Usage
·Suggestions for outreach improvement 

The survey will take approximately 8-10 minutes to complete the 25 questions. You may begin the survey by answering the following questions:
1.What is your Age?(Required.)
2.What is your Ethnicity?(Required.)
3.What is your Gender?(Required.)
4.What is your Highest Level of Education?(Required.)
5.Do you live in a city outside of the city of Chicago?(Required.)
6.Please select the county that you currently live in?(Required.)
7.Please select the type of insurance you have had over the past 12 months.(Required.)
Current Progress,
0 of 25 answered