The TakeCHARGE Campaign encourages people to be informed and active participants in their health care by planning ahead before becoming patients, using the 5 Steps to Safer Health Care!                 

The TakeCHARGE Campaign is an ambitious public awareness campaign that has significant potential to improve patient outcomes and safety.

Thank you for helping by completing this short survey and sharing it with others.

The first two questions are for demographics.

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* 1. Age

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* 2. Zip Code

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* 3. Are you familiar with the term "Advance Directive?"

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* 4. Do you currently have an Advance Directive form that appoints a trusted person who knows your wishes to make health care decision for you if you are unable to speak for yourself in an emergency or medical event?

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* 5. If you have an Advance  Directive where do you keep it?

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* 6. Has the TakeCHARGE Campaign influenced your thoughts or behavior about advance directives?  Please rate on a scale of 1-10 with 10 being strongly influenced.

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* 7. Comments

0 of 7 answered
 

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