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Medical Debt: Know Your Rights Post-Training Survey
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1.
What are your initials?
(Required.)
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2.
What county in Indiana are you from?
(Required.)
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3.
How useful did you find this training?
(Required.)
Extremely useful
Very useful
Somewhat useful
Not so useful
Not at all useful
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4.
After this training, how confident do you feel in handling your medical bills or medical debt?
(Required.)
Extremely confident
Very confident
Somewhat confident
Not so confident
Not at all confident
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5.
How likely do you think you will use this information to address your medical bills?
(Required.)
Very likely
Likely
Somewhat likely
Unlikely
Very unlikely
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6.
Will you ask for financial assistance or a payment plan for your medical bills or debt?
(Required.)
I plan to ask for financial assistance/charity care
I plan to ask for a payment plan
I have already asked for financial assistance/charity care
I have already asked for a payment plan
It is too late for me to ask for financial assistance or a payment plan (medical debt sent to collections)
I do not plan to ask for these
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7.
Do you think by using what you learned today, you will have an easier time paying for food?
(Required.)
Yes
No
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8.
Do you think by using what you learned today, you will have an easier time paying for housing costs such as rent or your home mortgage?
(Required.)
Yes
No
9.
What was the most useful thing you learned today?
10.
What is one suggestion to improve our trainings for the future?
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11.
Would you like to be added to our email list to be updated on future Institute workshops, and research or advocacy opportunities?
(Required.)
Yes
No