WIC Knowledge and Experience Pre/Post Video Survey

Demographics and Experience with WIC

Please complete this portion PRIOR TO watching the educational video.

The following questions will provide personal demographics and experience as it pertains to the Women Infant and Children Program (WIC).

Question Title

* 1. What is your medical role?

Physician

PA/NP

Nurse

Other (please specify)

Question Title

* 2. What is your medical specialty?

Family Medicine

Obstetrics

Pediatrics

Other

Question Title

* 3. In what state are you presently stationed/located?

Question Title

* 4. What is your gender?

Man

Woman

Nonbinary

Prefer not to answer

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* 5. What is your ethnicity?

Hispanic or Latino

Not Hispanic or Latino

Question Title

* 6. What is your race? (Check all that apply)

American Indian or Alaska Native

Asian or Asian American

Black or African American

Middle Eastern or North African

Native Hawaiian or other Pacific Islander

White

Prefer not to answer

Question Title

* 7. What is your military rank?

E1 - E4

E5 - E6

E7 - E9

O1 - O3

O4 - O6

O7 - O10

Civilian

Prefer not to answer

Question Title

* 8. Do you have any personal experience with WIC - Experience may include person and/or family utilization of WIC benefits or as a medical provider referring/recommending families to utilize WIC? (Check all that apply)

No, I do not have any personal experience with WIC.

Yes, I have experience both personally and professionally with WIC.

Yes, I have professional experience referring/recommending WIC to patients.

Yes, I have personal experience utilizing WIC benefits.

WIC Knowledge and Experience Pre/Post Video Survey

Demographics and Experience with WIC

Question Title

* 1. What is your medical role?

Question Title

* 2. What is your medical specialty?

Question Title

* 3. In what state are you presently stationed/located?

Question Title

* 4. What is your gender?

Question Title

* 5. What is your ethnicity?

Question Title

* 6. What is your race? (Check all that apply)

Question Title

* 7. What is your military rank?

Question Title

* 8. Do you have any personal experience with WIC - Experience may include person and/or family utilization of WIC benefits or as a medical provider referring/recommending families to utilize WIC? (Check all that apply)

Question Title

* 9. Please elaborate on your experience with WIC.