Copy of Reasons for Missing Primary Care Appointments or Health Screening in 2020-2021

Question Title

* 1. Were you afraid of contracting the COVID-19 virus?

Yes

No

Other (please specify)

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* 2. Is childcare or family care an issue for you?

Yes

No

Other (please specify)

Question Title

* 3. Can you afford healthcare costs for medication, co-pay, or therapy?

Yes

No

Other (please specify)

Question Title

* 4. Is reliable transportation or parking a barrier to your care?

Yes

No

Other (please specify)

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* 5. Did you have a bad experience with the staff or MD?

Yes

No

Other (please specify)

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* 6. Do you have internet access, a smartphone, computer, or iPads?

Yes

No

Other (please specify)

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* 7. Do you have health insurance?

Yes

No

Other (please specify)

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* 8. Did you forget you had an appointment?

Yes

No

Other (please specify)

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* 9. Did you receive any appointment reminder calls or texts?

Yes

No

Other (please specify)

Question Title

* 10. Do you have difficulty getting time off from work or were you unemployed?

Yes

No

Other (please specify)