Take Charge! Survey

1
Are you a South Country Health Alliance member?
YESNO
2
What Be Rewarded™ Preventive and Well-Care Rewards Vouchers have you completed in the last six months (select all that apply)?
Prenatal Care Voucher
Postpartum Care Voucher
Infant Checkups Voucher
Well-Child Visit Voucher
Child & Adolescent Well-Care Visit Voucher
Childhood Immunizations Voucher
Immunizations for Adolescents Voucher
Lead Tests Voucher
Chlamydia Testing Voucher
Preventive Dental Care Voucher
Colorectal Cancer Screening Voucher
Breast Cancer Screening Voucher
Cervical Cancer Screening Voucher
None
3
How satisfied are you with South Country's Be Rewarded incentive voucher program?
Very Satisfied
Satisfied
Neither Satisfied or Dissatisfied
Dissatisfied
Very Dissatisfied
4
What helped you decide to complete the preventive care service?
Information about the benefits of preventive care services when I first enrolled.
Reading about the reward programs in The Connection member newsletter.
The health care information included on the preventive care voucher.
A public health nurse encouraged me to complete the service.
The South Country mailings reminding me that I or my child may be eligible for the service.
The service is covered by my or my child’s health insurance.
My or my child’s health care provider (doctor, nurse, etc.) encouraged me to complete the service.
The chance to receive a gift card from South Country for completing the service.
The dollar amount of the gift card from South Country for completing the service.
The importance of wellness and staying healthy.
Other
5
Where do you get your information about health and wellness services?
My health care provider (doctor, nurse, etc.)
My care coordinator
County public health (WIC clinic, public health nurse, etc.)
South Country Health Alliance member materials (Member Handbook, Take Charge! Brochure, etc.)
South Country Health Alliance website
South Country Health Alliance Facebook page
Friends or family
Other
6
How likely would you have completed the preventive care service if the reward had not been offered?
Very Likely
Likely
Neither Likely nor Unlikely
Unlikely
Very Unlikely
7
Do you have suggestions for improving the South Country reward program?
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Ok
8
We want to know the best ways to give you information about your health care benefits and our health and wellness programs. Please answer the following questions.
9
Do you have access to the internet?
YESNO
10
If YES, what is the source of your internet access?
Personal computer/tablet
Computer/tablet at work
Computer/tablet of friend or family
Computer at a public library
Personal cell phone
Work cell phone
Cell phone of a friend or family
11
What is your preference for receiving health and wellness information from us?
Email
Postal mail
Text message
Phone call
No preference
I have no interest in receiving health and wellness information from South Country.
12
Would you be interested in participating in a member advisory forum/committee to give us feedback?
YESNO
13
EmailIf you are interested in participating, please add your email address below.
example@example.com
Confirm Email
14
What would be the best way for us to hold meetings to get feedback?
Virtual meeting on the computer/phone
In-person meeting in your community
Hybrid meeting (a combination of the above two)
Other
15
When is the best time to hold a meeting?
Morning (8 a.m. to noon)
Afternoon (Noon to 6 p.m.)
Evening (After 6 p.m.)
16
What health care topics are you curious about that would be good to discuss at a member advisory meeting?
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Ok
17
Any other thoughts you would like to share?
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Ok
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