Hep Spring 2017 Survey

HEP READER SURVEY - SPRING 2017
We want to hear from you! Please fill out the following survey. We appreciate your feedback.
1) Have you ever been tested for hepatitis C virus (HCV)?

Yes (skip to question 3)No
2) Why haven’t you been tested for HCV? (Check all that apply.)

I don’t believe I am at riskI don’t know how/where to get testedI don't want to face the resultsOther
3) Do you know how HCV is transmitted?

YesNo
4) Are you aware of the risk factors for HCV?

YesNo
5) Are you aware of the various treatment options available for HCV?

YesNo
6) Are you aware that there are programs available to help pay for HCV treatment?

YesNo
7) Are you currently receiving, or have you ever taken, treatment for HCV?

Yes—I'm currently on treatmentYes—I was treated in the past and am now curedYes—I was treated in the past, but it did not workYes—I was treated in the past but stopped earlyNo—I have never been treated for HCV
8) After reading this issue, will you talk to others about getting tested for HCV?

YesNo
9) Please rate the overall quality of this issue of Hep magazine.

ExcellentGoodFairPoor
10) What year were you born?
11) What is your gender?

MaleFemaleTransgenderOther
12) What is your sexual orientation?

StraightGay/lesbianBisexualOther
13) What is your yearly household income?

Less than $15,000$15,000–$34,999$35,000–$49,999$50,000–$74,999$75,000–$99,999$100,000 or more
14) What is your ethnicity? (Check all that apply.)

American Indian or Alaska NativeArab or Middle EasternAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or other Pacific IslanderWhiteOther
15) What is your zip code?
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HEP READER SURVEY - SPRING 2017