Physician Details
Do you personally have a _________ physician; that is, one you feel you could call if you needed medical attention?
Yes
No
Don't know
If you answered yes, please answer the following five questions.
What kind of physician is he/she?
Pediatrician
OB/GYN
Family/General Practice
Internist
Other
Where is your personal physician located?
Do you use the same physican for most of your personal medical needs?
Yes
No
How likely are you to switch hospitals on your physician's advice (from your preferred hospital)?
Very likely
Somewhat likely
Somewhat unlikely
Very unlikely
Not sure
Have you ever been hospitalized; if yes, when was the last time you were hospitalized?
Never been hospitalized
Hospitalized during the last 6 months
6 months to 1 year
1 - 5 years
Over 5 years ago
If you have been hospitalized: Thinking back to your last hospitalization, would you say you chose your physician first or the hospital first?
Physician
Hospital
Both
Don't know
Hypothetically, if you needed to be hospitalized, would you choose your physician or your hospital first?
Physician
Hospital
Not sure
Depends
Age category:
< 18
18 - 30
31 - 44
45 - 54
55 & over
Have you been hospitalized for OB/Maternity?
Yes
No
When were you last hospitalized for OB/Maternity?
During the past year
1-5 years ago
Over 5 years ago
Where were you last hospitalized for OB/Maternity care?
Have you ever been hospitalized for anything other than OB/Maternity?
Yes
No
If yes: When were you last hospitalized for non-OB care?
During past year
1-5 years ago
Over 5 years ago
Where were you last hospitalized for non-OB care?
Number of children delivered:
None
1-2
3-5
Over 5