Event Health Services Patient Survey

About You

Question Title

* 1. Are you?

Female

Male

Identify as neither female or male

Question Title

* 2. Prior to seeking assistance from St John, how would you rate your health?

Excellent

Very Good

Good

Fair

Poor

Question Title

* 3. What is your age group?

0 - 5 yrs

6 - 12 yrs

13 - 18 yrs

19 - 25 yrs

26 - 35 yrs

36 - 45 yrs

46 - 60 yrs

61 - 70 yrs

71 or Over