Real Health Spring 2009: Tell us what you think about Real Health

Speak Your Mind!

 
1. Name:
 
2. Organization (if you represent one)
 
3. Street address:
 
4. City & state:
 
5. Zip Code:
 
6. Email:
 
7. Phone:
 
8. What year were you born?
 
9. Gender:
Female
Male
Transgender
Other
 
10. 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
 
11. What is the highest level of education attained?
Some high school
High school graduate
Some college
Bachelor’s degree or higher
 
12. What is your ethnicity?
American Indian or Alaska Native
Arab or Middle Eastern
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
White
Other
 
13. Where do you get Real Health?
I’m a subscriber
My doctor’s office
My church
A community or college organization
It was mailed to my home or office
Other: ___________
 
14. Do you have Internet access?
Yes
No
 
15. Which of the following conditions, if any, do you currently suffer from? (Check all that apply.)
Anxiety/depression
Asthma
Diabetes
Heart disease
Hepatitis
High blood pressure
High cholesterol
HIV/AIDS
Kidney disease
Other: ___________
None
 
16. For which of the following conditions, if any, are you currently taking medication? (Check all that apply.)
Anxiety/depression
Asthma
Diabetes
Heart disease
Hepatitis
High blood pressure
High cholesterol
HIV/AIDS
Kidney disease
Other: ___________
None
 
17. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in the Health News section of the magazine.
1
2
3
4
5
 
18. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in the Nutrition Health section of the magazine.
1
2
3
4
5
 
19. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in the Sexual Health section of the magazine.
1
2
3
4
5
 
20. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in the Fitness News section of the magazine.
1
2
3
4
5
 
21. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in the Cover story (Beverly Johnson) in the magazine.
1
2
3
4
5
 
22. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in the Cancer story in the magazine.
1
2
3
4
5
 
23. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in the Food Allergies story in the magazine.
1
2
3
4
5
 
24. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in the Hair Health section of the magazine.
1
2
3
4
5
 
25. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in the Heroes story in the magazine.
1
2
3
4
5
 
26. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in seeing stories on arts/entertainment/celebrities in future issues.
1
2
3
4
5
 
27. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in seeing stories on beauty/skin care/hair care in future issues.
1
2
3
4
5
 
28. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in seeing stories on dating/relationships in future issues.
1
2
3
4
5
 
29. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in seeing stories on family/parenting in future issues
1
2
3
4
5
 
30. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in seeing stories on fitness/exercise in future issues.
1
2
3
4
5
 
31. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in seeing stories on food/diet/nutrtion in future issues.
1
2
3
4
5
 
32. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in seeing stories on health issues in future issues.
1
2
3
4
5
 
33. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in seeing stories on HIV/STIs in future issues.
1
2
3
4
5
 
34. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in seeing stories on mental health/self-help in future issues.
1
2
3
4
5
 
35. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in seeing stories on news/politics in future issues.
1
2
3
4
5
 
36. On a scale of 1 (not interested) to 5 (very interested), please rate your interest in seeing stories on sexual health in future issues.
1
2
3
4
5
 
37. Please share any other comments.