All survey participants who provide contact information will be placed in a drawing for one of four $50.00 VISA gift cards.  The survey will close-out at midnight on Feb. 16, 2018.  The drawing will be held on Feb. 19, 2018.   Winners of the drawing will be notified.  Participants can also complete the survey anonymously. 


* 1. To participate in the prize drawing, please provide the following contact information (leave blank if you want to participate anonymously):

* 2. Where do you go when you need basic medical care?

* 3. In the past 12 months, have there been times when you needed medical help but chose NOT to seek it?

* 4. If YES, why did you NOT get care?

* 5. How would you rate the need for healthcare services for ADULTS in the area?
Basic medical services – Primary Care

* 6. How would you rate the need for healthcare services for ADULTS in the area?
Specialized care doctors (for diabetes care, heart disease care, back problems, etc.)

* 7. How would you rate the need for healthcare services for ADULTS in the area?
Dentistry

* 8. How would you rate the need for healthcare services for ADULTS in the area?
Mental health (for example, depression, anxiety, suicidal thinking, anger management, and others)

* 9. How would you rate the need for healthcare services for ADULTS in the area?
Substance abuse – drug abuse treatment

* 10. How would you rate the need for healthcare services for CHILDREN in the area?
Basic medical services – Primary Care

* 11. How would you rate the need for healthcare services for CHILDREN in the area?
Specialized care services (for diabetes care, heart disease care, back problems, etc.)

* 12. How would you rate the need for healthcare services for CHILDREN in the area?
Dentistry

* 13. How would you rate the need for healthcare services for CHILDREN in the area?
Mental health (for example, depression, anxiety, suicidal thinking, anger management, and others)

* 14. How would you rate the need for healthcare services for CHILDREN in the area?
Substance abuse – drug abuse treatment

* 15. What physician specialties or additional physician specialties do you think are needed for our region?  Examples: family medicine, pediatrics, obstetrics/gynecology, orthopedics, dermatology, etc.  Leave blank if you think our region has an adequate contingent of physician specialties.

* 16. If you wanted to pick the top three healthcare needs in the area, what would they be?

* 17. About you:
Age Group

* 18. About you:
Gender

* 19. About you:
Race or Ethnicity

* 20. About you:
Language

* 21. About you:
What is your home county

For questions 22-24, we are going to ask you to rank the top 3 most-effective ways to reach you as a consumer.

* 22. In regards to information about Tift Regional’s providers and services, what is the #1 way to connect with you as a consumer? Choose only one.

* 23. In regards to information about Tift Regional’s providers and services, what is the #2 way to connect with you as a consumer? Choose only one.

* 24. In regards to information about Tift Regional’s providers and services, what is the #3 way to connect with you as a consumer? Choose only one.

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