Providence Internet Visitor Survey

Page 1   At Providence Health & Services Alaska, your feedback is very important to us. We are interested in learning about your experiences with our Web site so that we may continue to provide on-line services that meet your current and future needs. Please take a few minutes to answer the following questions. Data from this survey is confidential and will be presented only in aggregate form.   1. Your Gender:   Male Female       2. Your Age:   30 or Under 31-40 41-50 51-60 61-70 Over 70       3. Your City:         4. What is your relationship to Providence Health System in Alaska?   Patient Visitor Doctor/Nurse Employee Other       5. Please rate our site in the following areas:       Poor   Fair   Good   Excellent Site Design         Links & Navigation         Ease of Use         Quality of Information         Overall Site Rating               6. How often do you use the Web to gather health information?   First Time Daily Weekly Monthly Rarely       7. When using the Web to gather health information, do you usually go to a specific medical Web site, or do you go to a search engine like Google or Yahoo?   Search Engine   Medical Web site, please specify:               8. How did you hear about our Web site?   Search Engine (Google, Yahoo, etc.)   Advertisement (TV, Radio, Newspaper, etc.)   Referred by Doctor/Nurse   Referred by Family/Friend   Link from another Web site   Other, please specify               9. What is the main reason for your visit today?   Information about a specific disease or medical problem   Information about a medical treatment or procedure   Fitness and nutrition information   Depression, anxiety, or other mental health information   Help finding a doctor or other health care provider   About Providence (services, locations, who to call, etc.)   Career opportunities and/or employee benefits   Classes, Events, and Community Forums   Other, please specify               10. Did you find the information you were looking for?  If so, was the information helpful?   Yes. Very helpful   Yes. Somewhat helpful   Yes. Not very helpful   No. I did not find it       11. How likely are you to use the following Web site features:       Very Likely   Likely   Undecided   Unlikely   Very Unlikely Pre-Registration           Medical Records           Refill Prescriptions           View Lab Results           Nurse Advice           Health eNewsletters           Class Registration           Email a Patient           Web Nursery                 12. Additional Comments: Please provide any suggestions or comments that you may have about our Web site.         13. Your email address: (optional)         14. May we send you health information via email?   Yes No