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Mobile Primary Care Medical Clinic Survey
1.
How satisfied are you with your current access to healthcare?
Very satisfied
Satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Dissatisfied
Very dissatisfied
2.
What type of health insurance do you currently have?
None
Medicaid
Medicare
Vermont Blue Cross Blue Shield
MVP
Other
3.
What primary care services do you most need? (Select all that apply)
Preventive Care
Illness/Injury/Urgent Care
Chronic Disease Management
Prenatal/Obstetric Care
Pediatric Care
Mental Health
Geriatric/Elderly Care
Addiction
4.
How far do you currently have to travel to see a primary care provider?
Less than 5 miles
5-10 miles
11-20 miles
More than 20 miles
5.
Do you have reliable transportation to visit a primary care provider?
Always
Usually
Sometimes
Rarely
Never
6.
How often do you typically need access to a doctor?
Weekly
Monthly
Every few months
Once a year
Only when sick
7.
What issues commonly make obtaining healthcare more difficult?
Long waits for an appointment
Travel distance
Lack of insurance
Insurance with high deductible/out of pocket cost
Lack of extended hours
Lack of transportation
High out of pocket medication cost
Other (please specify)
8.
If a mobile clinic were to come to your area, how often would it need to come in order to be beneficial?
Twice a week
Once a week
Once every two weeks
Once a month
Don't know
9.
Where do you live?
10.
Please add any specific concerns or needs that were not asked about directly.