Thank you for taking your time to complete this survey. We hope you enjoyed Better Choices Better Health workshop you attended last year.

Question Title

1. ID Number (Enter the ID number provided by your workshop leader) (Required.)

Question Title

2. Today’s Date:

Date

Question Title

3. In the past 6 months, how many TIMES did you visit a physician? Do not include visits while in the hospital or the hospital emergency department (also called an emergency room or ER).

Question Title

4. In the past 6 months, how many TIMES did you go to a hospital emergency department (also called an emergency room or ER)?

Question Title

5. In the past 6 months, how many TIMES were you hospitalized one night or longer?

Question Title

6. How many total NIGHTS did you spend in the hospital in the past 6 months?

Thank you for your help!

Better Choices Better Health – Ke Ola Pono

A project of Hawai‘i’s Healthy Aging Partnership
( Privacy & Cookie Notice

T