1. Rural Outreach Survey

The MS Society seeks to increase the number of MS specialists and access to specialized MS care in rural areas. We need your help in completing this survey to help us identify and reach out to health care providers as well as help us with identifying where Society resources need to be used to reach people in rural areas.

The survey that follows should only take about 5-10 minutes to complete. You can decline to answer a question and can stop the survey at any time. The information you provide will be grouped together and no names will be attached to responses. If you have any questions, please ask a chapter staff or volunteer for help.

* 1. In which county do you reside?

* 2. Which of the following best describes your MS?

* 3. Are you on a MS disease-modifying therapy (Avonex, Betaseron, Copaxone, Rebif, Extavia, Gilenya, Tysabri and Novantrone)?

* 4. Why are you not on a MS disease-modifying therapy? (Check as many that apply).

* 5. Where do you get information about MS and MS related resources? (Check all that apply).

* 6. How did you learn about the MS Society?

* 7. Are there services you need that you are not getting?

* 8. What are the services you need that you are not getting? (Check as many that apply).

* 9. Have you ever seen a neurologist about your MS?

* 10. Is there a physician you see specifically for your MS?

* 11. Which of the following describes the medical speciality of the doctor you see specifically for MS care?

* 12. What is the name and location of your MS doctor?

* 13. How far do you travel for your MS doctor?

* 14. Are you satisfied with your care from your MS doctor?

* 15. Are there any barriers or issues that prevent or hinder you from getting all the MS care you want or need from your MS care provider?

* 16. If you answered yes to question 15, please check and list any barriers or issues that keep your from getting the MS care you want or need from your MS care provider. (Check as many that apply).

* 17. Have you worked with a physical or occupational therapist related to your MS?

* 18. What is the name and location of the physical and/or occupational therapist?

* 19. Have you met with a therapist (counselor/social worker/psychologist/psychiatrist) to discuss MS related issues?

* 20. What is the name and location of the therapist?

* 21. Did you find the counseling beneficial?