Helpline User Survey

User Profile Survey

Please take the time to complete our survey. Your feedback will help us improve & design our service. Thank you.

Your Email Address

Which of the following best describes you?

patient
family caregiver
medical company representative or employee
nurse
doctor
pharmacist
other (please specify)

Do you have access to the internet?

yes

If yes where do you have access from? (mark all that apply)

home

work

schoolother

I have this level of computer skills particularly regarding Internet usage

none

low

moderate

high

expert

What interest level do you have in using our services?

none

low

moderate

high

definite

Do you feel our sites will be easy to use.

Agree

Somewhat Agree

Neutral

Somewhat Disagree

Disagree

Which of our helplines would you be interested in using? (mark all that apply)

allergycarehelpline.com	anxietyhelpline.com	cancercarehelpline.com	colitishelpline.com	cosmetichelpline.com	deafnesshelpline.com
dentalcarehelpline.com	dermatologyhelpline.com	diabetichelpline.com	dialysishelpline.com	eyehelpline.com	first-aidhelpline.com
footcarehelpline.com	fracturehelpline.com	geriatrichelpline.com	healthyskinhelpline.com	hiv-aidshelpline.com	hypertensionhelpline.com
incontinencehelpline.com	infectionhelpline.com	irritablebowelhelpline.com	nutritionalhelpline.com	ostomyhelpline.com	pediatrichelpline.com
sexualdiseasehelpline.com	sportsinjuryhelpline.com	stayhealthyhelpline.com	surgicalhelpline.com	woundcarehelpline.com	none

Will you subscribe to our service?

yes

probably

possibly

How would you like to pay for our interactive services?

free site only
monthly, by post
monthly, by credit card (phone)
monthly, by credit card (internet)
annually, by post
annually, by credit card (phone)
annually, by credit card (internet)
other (please specify)

Please provide any comments or suggestions regarding the design and improvement of our service?

Indicates Response Required