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* 1. What is your age?

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* 2. Do you currently have medical aid (insurance)?

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* 3. Do you make use of private healthcare facilities

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* 4. How do you make appointments?

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* 5. Do you own a smartphone or tablet (device)?

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* 6. Do you access any of the following online?

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* 7. During the past year, were you prescribed a medicine but were unable to get it?

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* 8. In what language do you prefer to speak with your doctor

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* 9. How do you personally evaluate the importance of the following aspects of coordinated care?

  Not
Important
Less
Important
Important Very Important
Book Change and cancel appointments online
Receive reminders
Refill prescriptions online
Communicate with providers via secure email
Access medical records electronically
Have full access to your medical records
Flexibility of seeing a doctor out of town with your medical history available
Having your chronic meds delivered to you periodically
Quick access to medical assistance

T