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Healthcare Study - P261004

Please provide us with your First and Last Name

*

Please provide us with your email address.

*

What is your current home zip code?

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How do you currently get your health insurance coverage?

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Through my employer

Through a family member’s employer (e.g., spouse, partner, parent)

Purchased directly from a health insurance company

Purchased through the Health Insurance Marketplace (Healthcare.gov or state exchange)

Through Medicaid

Through Medicare

Through another government program (e.g., TRICARE, VA)

I do not currently have health insurance

Other

Which of the following hospitals or health systems have you used most often for healthcare for yourself or for a family member whose healthcare decisions you help make?

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A

Sentara Norfolk General Hospital

B

Sentara Leigh Hospital

C

Sentara Virginia Beach General Hospital

D

Sentara Princess Anne Hospital

E

Sentara CarePlex Hospital

F

Sentara Obici Hospital

G

Sentara Williamsburg Regional Medical Center

H

Chesapeake Regional Medical Center

I

Bon Secours Mary Immaculate

J

Bon Secours Maryview Medical Center

K

Bon Secours-Southampton Medical Center

L

Portsmouth Naval Hospital

M

Riverside Regional Medical Center

N

Riverside Doctors’ Hospital Williamsburg

O

Riverside Walter Reed Hospital

P

Hampton Veterans Affairs Medical Center

Q

I do not have a usual hospital or health system

R

Other

When visiting a hospital or healthcare facility, who usually provides transportation?

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A

I drive myself

B

A family member or friend drives me

C

I use a ride-sharing service (taxi, Uber, Lyft, etc.)

D

I use public transportation

E

I use transportation services arranged through Medicare

F

I use transportation arranged through Medicaid, another health insurance plan, or a healthcare provider

G

Walk

H

Other