This anonymous survey of ACCMA members will help shape the organization’s activities regarding health care disparities among patients. The survey will take up to 5 minutes.

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* 1. Practice size:

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* 2. Do you see inequities among your own patients? Check all that apply:

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* 3. Do you see health disparities among your own patients? Check all that apply:

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* 4. What are some determining factors leading to health inequities among your own patients (if known or discussed with patients)?

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* 5. Have you previously engaged in health equity training or other anti-racism training?

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* 6. Please indicate the degree to which you agree or disagree with each statement:

  Strongly Disagree Somewhat Disagree Neutral Somewhat Agree Strongly Agree
Racial bias affects health status.
Socioeconomic disparities affect health status.
Racism is a public health emergency.

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* 7. Please select the options that apply to you:

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* 8. I would attend anti-racism training sponsored by the ACCMA.

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* 9. I identify as:

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* 10. My suggestion(s) for the ACCMA on these topics mentioned above:

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* 11. What are your thoughts about the ACCMA developing a designated Health Equity Task Force?

Thank you for participating in this survey! Your time is very much appreciated.

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