Health Care Questionnaire

Do you understand how healthcare reform will impact you and your company?

Yes

No

Where is your primary source of educational information regarding the impact of healthcare reform??

Medical Providers (Physicians, Hospitals, ect.)

Insurance Company

Internet

Broadcast Media (TV/Radio)

Newspaper

Other

Does your organization provide health insurance to Full-Time and Part-Time employees?

Full-Time only

Part-Time only

Neither

Are you or your employees delaying care due to high health insurance co-pays and/or deductibles?

yes

no

If you are a business owner, do you have the appropriate Worker's Compensation plan for your employees?

yes

no

Approximately how many Full-time Equivalents are employed in your organization? (1FTE= Work more than 30 hours per week)

0-24

25-49

50-99

More than 10

What is the most important factor when deciding where to receive medical care?