Please feel free to skip any question that may not apply. We appreciate your time taking this survey. Thank you.

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* 1. Overall, how satisfied are you with the quality of health care in your community?

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* 2. How would you rate the availability of health care in your community? Please use a 5-point star scale, with 1 star being very poor and 5 being excellent. Please hover over and click on the star that applies. 

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* 3. In general, how much do you trust healthcare providers in your community? Please use a 5-point star scale with 1 star being you don't trust them at all and 5 being you trust them a great deal. Please hover over and click on the star that applies. 

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* 4. Why do you feel this way?

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* 5. Do you have a regular doctor/primary care physician you use when needing medical care?

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* 6. If you have a regular doctor/primary care physician, how satisfied are you with them?

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* 7. How many days does it usually take to get an appointment with your regular doctor for non-urgent medical care?

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* 8. How many days does It usually take to get an appointment for a more urgent medical need such as minor illness or injury?

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* 9. How long does it take you to get to your doctor’s office from your home:

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* 10. Please rate the overall convenience of the location of your doctor’s office, using a 5 point star scale with a 1 star being very inconvenient and 5 being very convenient. Please hover over and click on the star that applies. 

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* 11. Thinking of the most recent time you needed medical care, did you go to your regular doctor or somewhere else?

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* 12. Why didn’t you go to see your regular doctor?

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* 13. If you had to find a new doctor/practice, what would you do to find one (select all that apply)?

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* 14. Based on what you know or have heard, how difficult is it to find a new primary care doctor in the Albuquerque area? Please use a 5-point star scale, with 1 star being very difficult and 5 being very easy. Please hover over and click on the star that applies. 

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* 15. Below, please find a list of places you could seek primary healthcare.  Using a scale, how 'likely' or 'unlikely' would you be using each location for healthcare services, where a 5 is very likely and a 1 is very unlikely.


  Very Unlikely Unlikely Neutral Likely Very Likely Don't Know / Won't Say
An Urgent Care Center
Retail clinic at a a pharmacy or grocery store
A mobile healthcare clinic at a community center
A healthcare clinic in a faith-based nonprofit organization
A family healthcare clinic

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* 16. If a new primary healthcare clinic was opening in your neighborhood, how likely would you be to use it?

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* 17. Would you choose the convenience of receiving medical care in a neighborhood clinic located in a church or faith-based organization?

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* 18. Would you trust a medical provider located in neighborhood clinic in a church or faith-based organization?

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* 19. Do you have hesitancy to receive care or any trust issues as it relates to healthcare?

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* 20. What is the highest level of education you have had an opportunity to complete?

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* 21. Into which age category do you fit?

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* 22. Thinking of your health insurance, do you have Medicare only, a Senior “Advantage” Health Plan or do you have Medicare plus a supplement?

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* 23. Do you have any type of health insurance, or perhaps Medicaid Centennial Care? If so, do you have a regular health insurance plan or Medicaid Centennial Care (if not, please skip to the next question)?

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* 25. What is your total household income category?

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* 26. What is your gender?

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* 27. Do you consider yourself to be, Hispanic, Anglo, Native American Indian, Black/African-American, Asian/Asian American or of other descent?

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* 28. Anything else relevant that you'd like to share? 

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