LCHI Community Health Survey Question Title * 1. Your current age (years) 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99 Question Title * 2. Your Gender: Female Male Other (please specify) Question Title * 3. Your Ethnicity: Native Hawaiian Filipino Portuguese Chinese Caucasian Japanese African American Hispanic Other (please specify) Question Title * 4. What language do you most comfortable speaking? English Other (please specify) Question Title * 5. In the past year, how often have you received medical care on Lanai? Never 1-2 times 3-4 times 5-6 times More than 6 times Question Title * 6. How comfortable are you with video chatting (talking through the computer)? 1 - Very uncomfortable 2 - Somewhat uncomfortable 3 - Neither comfortable or uncomfortable 4 - Somewhat comfortable 5 - Very comfortable Question Title * 7. How comfortable would you feel sharing personal health information with a medical professional through a confidential video chat? 1 - Very uncomfortable 2 - Somewhat uncomfortable 3 - Neither comfortable or uncomfortable 4 - Somewhat comfortable 5 - Very comfortable Question Title * 8. Are you willing to try video chats for your medical needs? Yes No Other (please specify) Question Title * 9. what types of medical appointments might you be willing to have through video chat? Psychology/Psychiatry Urology OB/Gyn Endocrinology Dermatology Cardiology Pediatrics Allergist Other (please specify) Question Title * 10. What do you feel are the benefits of video chatting with the healthcare professional? Possible benefits: Convenience Save money Less travel Increased access to care Other (please specify) Question Title * 11. What do you feel are the drawbacks of video chatting? Possible drawbacks: Technical Issues Lack of personal connection Potential for misunderstanding Uncomfortable with technology Confidentiality concerns Other (please specify) Done