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How often do you go to the doctor?
 
Less than once a year
 
Once a year
 
More than once a year
 
 
 
How comfortable do you feel talking to your doctor about general health concerns?
Very Uncomfortable
Uncomfortable
Neutral
Comfortable
Very Comfortable
 
 
 
How comfortable do you feel talking to your doctor about sexual health issues?
Very Uncomfortable
Uncomfortable
Neutral
Comfortable
Very Comfortable
 
 
 
Do you agree with the statement "Doctor knows best"?
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
 
 
 
Have you heard of HIPAA before?
 
Yes
 
No
 
 
 
Do you feel that your doctor listens to you?
Strongly disagree
Disagree
Neutral
Agree
Strongly Agree
 
 
 
Have you ever made a doctor's appointment on your own?
 
Yes
 
No
 
 
 
Please rank (1-4) the following you prefer to use for school. 1 representing the top choice and 4 representing the bottom choice.
Laptop computer
Desktop computer
Phone
Tablet
 
 
 
Would you rather share personal information to your doctor using a computer or face-to-face?
 
Computer
 
Face-to-face
 
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