Closing of Atlanta Medical Center Impact Survey
We want your voice to be heard! Please take 2 - 5 minutes to tell us more about how the closing of Atlanta Medical Center impacts you
What is your gender?
Female
Male
Non-binary
Prefer not to answer
What is your age range?
0-17
18-24
25-34
35-44
45-54
55-64
65+
What is your zip code?
What is your marital status?
Single
Married
Divorced
Widowed
Prefer not to answer
What is your annual income range?
$9,999 or less
$10,000-$24,999
$25,000-$49,999
$50,000-$74,999
$75,000-$99,999
$100,000 or more
Prefer Not to Answer
What is your employment status?
Employed full time
Employed part time
Self-employed
Unemployed
Not looking for a job
Homemaker
Student
Prefer not to answer
What is the highest level of education you have completed?
Less than high school
High school
Some college / University
College diploma / Certificate
Undergraduate degree
Masters / Graduate degree
Doctorate
Prefer not to answer
Other
Is Atlanta Medical Center the primary location you recieved medical care?
Yes
No
How many time in 1 year do you use Atlanta Medical Center for care?
1
2
3
4
5
6
7
8
9
Use '10' for 10 or more times in 1 year
10
1 is , 10 is Use '10' for 10 or more times in 1 year
How will the closing of Atlanta Medical Center impact you or those you provide care for?
It will not impact me at all
1
2
3
4
5
6
7
8
9
It will have an extreme impact
10
1 is It will not impact me at all, 10 is It will have an extreme impact
What is the main thing you want people in power to understand about the closing of Atlanta Medical Center?
Is there any additionjal information you'd like to add?
Would you like to be contacted by Hight Health to discuss more?
Yes
No
Name
First Name
Last Name
Please share your email address
example@example.com
Phone Number
Please enter a valid phone number.
Please verify that you are human
*
By clicking the 'Submit' button I agree that my responses are completely voluntary and of my own will.
Submit
Should be Empty: