Survey for SJC 2016

Because this survey includes "skip patterns," you will not be able to return to a previous question as you enter the data. You also will not be able to save a partially completed survey and return to it later. All questions will require an answer; the survey system will not allow you to move on until you have responded to all questions on the page.

Therefore, please do the following before you begin. First, be sure that you have enough time to enter all questions on the form in one session. Second, check the survey form to make sure you have clear answers to all the questions. Once you begin entering data, check the answers you have entered for accuracy at the end of each data entry page before you click on the "continue" button.

If you have any difficulty with the data entry process, please make a note of where in the survey the difficulty occured, then notify Stacy. If you need to delete a survey and start over, notify Stacy.

* Did the participant agree (consent) to be interviewed?

Yes

* [Enter the participant's study ID number.]

* Enter the date you conducted the interview.

Month	Day	Year

* How long (in months) have you been coming to St. John Center?

* During the past month, how often have you visited St. John Center?

1-2 times/month

1 time/week

2-3 times/week

4+ times/week