Member Survey

"*" indicates required fields

Thank you for your participation in this program. We’d like to check in and see how you’re doing. This should only take a minute.

Questions marked with an asterisk (*) are required.

Do you experience periodic acute pain?*

Yes

Do you feel you understand all your medication treatment options for your pain management?*

Yes

Somewhat, but not fully

Are you embarrassed or nervous to discuss your acute pain with your doctor?*

Yes

Somewhat

Does your acute pain require surgery?*

Yes

How important is it for you to understand how your acute pain will be managed after surgery?*

Very important

Somewhat important

Not important

If you were in need of surgery, would you create a list of questions to review with your physician, nurse practitioner (NP), physician assistant (PA), registered nurse (RN), etc.?*

Yes

If you were to require surgery, would you do any research before your procedure?*

Yes

If you have an injury that results in acute pain, what would your first action be to address the pain?*

(Please rank in order of importance with 1 being most important & 6 being least important)

Call your physician.
Go to Urgent Care. 
Self-treat with over-the-counter (OTC) medication such as ibuprofen, aspirin, etc. 
Call a friend who may have experienced that same ailment.
Use a homeopathic remedy like acupuncture, heat and ice, turmeric, etc.
Consult with a pharmacist.

Do you feel you have a better understanding of your pain management options?*

Yes

Do you feel more confident advocating for your pain management needs?*

Yes

Do you feel comfortable speaking to your healthcare provider about your pain management needs/options?*

Yes

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