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Sharp.com Research Sessions Sign-up Survey

Please complete the form if you are interested in participating in individual online research sessions for Sharp HealthCare. Your involvement allows us to improve sharp.com.

This survey should take less than 5 minutes to complete.

*1.Please provide the following information.(Required.)

First Name:

Last Name:

ZIP:

Email Address:

Phone Number:

*2.What is your age?(Required.)

*3.What is your gender?(Required.)

Female

Male

*4.Do you currently or have you previously worked at Sharp HealthCare?(Required.)

Yes

No

*5.Who do you make health care decisions for? Please check all that apply.(Required.)

Myself

My spouse

My children

My parents

Another family member or loved one

None of the above

*6.Are you an existing Sharp HealthCare patient?(Required.)

Yes

No

67%

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