Survey

We would like to ask you a few questions about how you feel after browsing this website as compared to how you felt before you read this material.

1.) How well do you understand the purpose of Advance Directives now as compared to before?
Less than before
About the same as before
A little more than before
Somewhat more than before
Much more than before

2.) How comfortable will you be discussing Advance Directives with your family as compared to before?
Less than before
About the same as before
A little more than before
Somewhat more than before
Much more than before

3.) How comfortable will you be discussing Advance Directives with your doctor as compared to before?
Less than before
About the same as before
A little more than before
Somewhat more than before
Much more than before

Next, we would like to ask about how ready you feel to move forward and complete an Advance Directive.

4.) Have you decided to complete and sign your Advance Directive form now?

Yes No I already have an Advance Directive signed

5.) Did this presentation provide you with enough information to make an informed decision about signing your Advance Directive?
Yes
No, I’d like for CARE staff to give me more information
I’ve decided I’m no longer interested

To help us understand why people are hesitant to complete an Advance Directive we are asking for your input. Please share with us why you did not complete your Advance Directive.

Finally, we ask that you select one of the two age groups below to help us in our record keeping.

5.) Your Age: 18 - 54    55 or older