Would you recommend this facility Are you male or female? to your friends and family? Male Definitely no Female Probably no What is the highest grade or level Probably yes of school that you have completed? Definitely yes 8th grade or less Some high school, but did not VI. graduate High school graduate or GED In general, how would you rate Some college or 2-year degree your overall health? 4-year college graduate Excellent More than 4-year college Very good degree Good Are you of Hispanic, Latino, or Fair Spanish origin? Poor Yes, Hispanic, Latino, or Spanish In general, how would you rate your overall mental or emotional No, not Hispanic, Latino, or health? Spanish If No, go to #32 Excellent Which group best describes you? Very good Mexican, Mexican American, Good Chicano Fair Puerto Rican Poor Cuban Another Hispanic, Latino, or What is your age? Spanish origin 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 79 80 to 84 85 or older
Would you recommend this facility to your friends and family? Definitely no Probably no Probably yes Definitely yes VI. In general, how would you rate your overall health? Excellent Very good Good Fair Poor In general, how would you rate your overall mental or emotional health? Excellent Very good Good Fair Poor What is your age? 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 79 80 to 84 85 or older Are you male or female? Male Female What is the highest grade or level of school that you have completed? 8th grade or less Some high school, but did not graduate High school graduate or GED Some college or 2-year degree 4-year college graduate More than 4-year college degree Are you of Hispanic, Latino, or Spanish origin? Yes, Hispanic, Latino, or Spanish No, not Hispanic, Latino, or Spanish If No, go to #32 Which group best describes you? Mexican, Mexican American, Chicano Puerto Rican Cuban Another Hispanic, Latino, or Spanish origin
HSSC-Patient-Survey-English.docx