Exploring Healthcare Through YOUR Stories and Experiences

PURPOSE of this Survey

The U.S. Healthcare System is very complex and it impacts you, your loved ones, your communities. I would like to explore with you your stories, your experiences, in receiving or providing healthcare services. So, grab a cup of coffee, tea or glass of wine and explore with me. Sharing your stories can make a difference for you and for others.

Deeanna Burleson, Ph.D., RN, IMC

dburleson@fullspectrumsolns.net

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* 1. Identify if you are a patient, family member or healthcare professional. If you are a healthcare professional and also have experiences as a patient please check both.

Patient or Receiver of Healthcare Services

Family Member

Healthcare Professional (identify discipline in the comment box)

Additional Information

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* 2. Describe the most satisfying experience in receiving or providing healthcare services.

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* 3. Describe the least satisfying experience in receiving or providing healthcare services.

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* 4. Would you be interested in participating in a larger research study as a patient or healthcare professional?

Yes

Maybe, would like more information

Other (please specify)

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* 5. If you answered yes or maybe to question #4 please enter your contact information. This information will never be shared with anyone other than myself nor used for any purpose other than following up on this survey.

Name

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

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* 6. APPRECIATION and THANK YOU
Thank you for participating in this survey. My desire and passion is to encourage all healthcare facilities to provide the structures that are needed for their customers (patients, families and professionals) to receive and provide the care that is needed for true health and well-being. Additional information can be provided in the following box.