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  2. 2013
  3. November
  4. D
  5. Demographice survey
0%
Exit Survey
 
 
What is your age?
 
Younger than 18
 
18 - 24
 
25 - 34
 
35 - 44
 
45 - 54
 
55 - 64
 
65 or older
 
Prefer not to answer
 
 
What is your gender?
 
Male
 
Female
 
 
 
What is the highest level of education you have achieved?
 
Less than high school degree
 
High school degree or equivalent (e.g. GED)
 
Some college but no degree
 
Associate degree (e.g. AA, AS)
 
Bachelor's degree (e.g. BA, AB, BS)
 
Master's degree (e.g. MA, MS, MBA)
 
Professional degree (e.g. MD, DDS, JD)
 
Doctorate degree (e.g. PhD)
 
 
 
What is your primary language?
 
Arabic
 
English
 
Korean
 
Spanish

 
 
 
What is your relationship to the patient?
 
Spouse
 
Significant Other
 
Parent
 
Child
 
Sibling
 
 
 
How long has the patient been in ICU?
 
Less than 24 hour
 
24hours - 36 hours
 
37 hours to 48 hours
 
more than 48 hours