Obamacare survey questions + sample questionnaire template

Obamacare Survey Template offers questions that provide insights into the quality of healthcare services. This sample can be edited by the survey maker according to the required details about Obamacare healthcare services. Some of the question examples of this questionnaire are "Which political party are you affiliated with?", demographic questions such as "Which of the following group of race do you fit best?", "What is your family income?" et al.

Obamacare survey questions + sample questionnaire template

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The Experience Journal


Please take a few minutes to fill out this survey on Obamacare which was passed into law in March 2010. We value your feedback and your responses will be used to serve you better. Thank you for your input. 1.What is your gender? Male Female 4.Which political party are you affiliated with? Republican Democrat I prefer not to answer Other 5.What is the highest level of education you have attained? Primary school Some high school but not diploma High school diploma Some college but not degree 2 year college degree 4 year college degree Graduate level degree Other 6.What is your marital status? Married Widowed Divorced Separated Single never married 7.Do you consider yourself disabled? Yes No 8.Please mark the level of your income per year? $0 to $9999 $10,000 to $24,999 $25,000 to $49,999 $50,000 to $99,999 $100,000 to $249,999 $250,000 and up 9.Which of the following group of race do you fit best? White Black or African American American Indian Asian Other 10.Overall how do you feel about the Affordable Care Act? Extremely like Moderately like Slightly like Neutral Slightly dislike Moderately dislike Extremely dislike 11.Have you been able to obtain cover since the Act was introduced in March 2010? Yes No 12.Have you been unable to meet health care cost in the past? Yes No 13.Has the Affordable Care Act reduced your health care cost? Yes No 14.Has the Affordable Care Act improved your access to healthcare? Yes No