Healthcare Survey Healthcare Profile A Question Title * 1. Have you or your family member(s) seen a medical doctor in the last 12 months for a health concern? Yes No Don't know Question Title * 2. Have you or your family member(s) seen an alternative medicine (or healing art) practitioner in the last 12 months for a health concern? NOTE: An alternative medicine practitioner may practice Acupuncture, Ayurveda, Chinese medicine, Chiropractic, Homeopathic, or Naturopathic medicine. Yes No Don't know Question Title * 3. Do you have a chronic illness? Note: A chronic illness may be one of the following: Acquired Hypothyroidism, Alzheimer's Disease or Senile Dimentia, Asthma, Atrial Fibrillation, Autism, Benign Prostatic Hyperplasia, Cancer (Colorectal, Endometrial, Breast, Lung, Prostate), Cataract, Chronic Back Pain, Chronic Debilitating Allergies (food, pollen, mold, etc.), Chronic Kidney Disease, Chronic Obstructive Pulmonary Disease, Depression, Diabetes, Glaucoma, Heart Disease or Failure, Hip / Pelvic Fracture Hyperlipidemia, Hypertension, Ischemic Heart Disease, Obesity, Osteoporosis, Rheumatoid Arthritis / Osteoarthritis, or Stroke / Transient Ischemic Attack. Yes No Don't know Question Title * 4. What chronic illness(es) do you and your family member(s) have? Select ALL that apply. Acquired Hypothyroidism Alzheimer's Disease or Senile Dimentia Asthma Atrial Fibrillation Autism Benign Prostatic Hyperplasia Cancer (Colorectal, Endometrial, Breast, Lung, Prostate, etc) Cataract Chronic Back Pain Chronic Debilitating Allergies (food, pollen, mold, etc.) Chronic Kidney Disease Chronic Obstructive Pulmonary Disease (COPD) Depression Diabetes Glaucoma Hip / Pelvic Fracture ( Hyperlipidemia) Hypertension Heart Disease Heart Failure Obesity Osteoporosis Rheumatoid Arthritis / Osteoarthritis Stroke / Transient Ischemic Attack Other No chronic illness Don’t know Decline to answer Next