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1. How did you hear about our sliding scale program? (Required.)

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2. How long have you been a participant of this program?

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3. How satisfied are you with the process of applying for the sliding scale program?

Very Dissatisfied Neutral Very Satisfied
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i We adjusted the number you entered based on the slider’s scale.

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4. Before participating in the Sliding Scale program, were you able to access healthcare services as needed?

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5. Since participating in the Sliding Scale program, has the ability to access healthcare services changed?

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6. Did the Sliding Scale program help you overcome any financial barriers that previously prevented you from seeking necessary medical care?

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7. Do you feel that the Sliding Scale discount you were assigned was fair and appropriate for your income level?

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8. How would you describe your overall experience with our sliding scale program?

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9. Please provide any suggestions or comments you have for improving our Sliding Scale program.

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