1.Which of the following best describes your situation?

I manage a chronic or long-term health condition myself

I am a caregiver for someone with a chronic or complex health condition

I have had a complex medical situation in the past (surgery, serious diagnosis, extended treatment)

None of the above

2.How many doctors, specialists, or healthcare providers are currently involved in your care (or the care of the person you support)?

1

2-3

4-6

7 or more

3.Have you ever struggled to access, transfer, or share your medical records when you needed them?

Yes, this has been a significant problem

Yes, occasionally

Rarely

Never

4.Have you ever received a medical bill that surprised you, or had a claim denied or underpaid by your insurance?

Yes, and I successfully resolved it

Yes, but I gave up trying to resolve it

Yes, still unresolved

No

5.On a scale of 1-5, how much time and stress does managing your health information — records, bills, insurance — add to your life?

1 - No burden at all

2

3

4

5 - Significant burden

6.Have you ever had to share your medical history or records with a new doctor, specialist, employer, or school? Briefly tell us what happened. (Optional)

7.What frustrates you most about managing your healthcare information today? (Optional)

8.Would you be open to a short 15-20 minute conversation about your experience? If yes, please leave your email / phone number below.