Real Health Fall 2008: Tell us about yourself and your health issues

Speak Your Mind!

Understanding our readers' needs is key to creating content that matters to you. Real Health wants to know who you are, what health issues you are dealing with and what topics you want to see in our publication.
 
1. Are you employed?
Employed, full-time
Employed, part-time
Freelance/contractor
On disability
Retired
Student
Unemployed
 
2. What year were you born?
 
3. What is your gender?
Male
Female
Transgender
Other
 
4. What is your household income?
Under $15,000
$15,000 - $34,999
$35,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 and over
 
5. What is your marital status?
Single, never married
Single, divorced or separated
Married
Unmarried, living together
Widowed
 
6. How many children do you care for?
1
2
3
4 or more
None
 
7. Do you have health insurance?
Yes, I have private insurance/Health Maintenance Organization (HMO)
Yes, I have private insurance/Point-of-Service Plan (POS)
Yes, I have private insurance/Preferred Provider Organization (PPO)
Yes, through Medicaid or Medicare
No, I am not insured
 
8. How often do you visit the doctor?
More than once a year
Every two years
Annually
It's been awhile
 
9. Do you suffer or have you experienced any of the following? (Check all that apply.)
Addiction
Asthma
Anxiety/depression
Cancer
Diabetes
Hepatitis
High blood pressure
HIV/AIDS
High LDL ("bad") cholesterol levels
Kidney disease
Sickle-cell disease
Stroke
None of the above
Other:
 
10. Are currently on prescribed medication?
Yes
No
 
11. How would you describe your general health?
Excellent
Pretty good
So-so
Not good
 
12. What are some of your biggest challenges to staying healthy (Check all that apply)
I can't find healthy food nearby
I don't have time or money to buy/cook healthy food
My family doesn't eat healthy food
I don't like healthy food
There is no gym near my home
I cannot afford a gym membership
It's not safe to walk near my home
I don't have time to excercise
I don't have time to excercise
I don't have health insurance
I don't have a good relationship with a doctor/care provider
 
13. What kinds of health-related stories would you like to see in the future issues? (Check all that apply)
Fitness/excercise
Food/diet/weight loss/nutrition
HIV/AIDS
Prescription meds/side effects/drug interactions
Mental health/self-help recovery
Parenting
Real-life health success stories
Safer sex/sexual health
Societal issues (homophobia, racism, sexism, discrimination)
 
14. Where do you get your copy of Real Health?
I'm a subscriber
My doctor's office
My church
A community or college organization
 
15. Name:
 
16. Organization (if you represent one):
 
17. Street address:
 
18. City & state:
 
19. ZIP code:
 
20. E-mail:
 
21. Phone: