18. In the last 12 months, did you and your primary doctor or nurse talk about specific 14. one of the following clinics do you go things you could do to prevent illness? to when you see your primary doctor or nurse? 1 Yes 2 No 1 [CLINIC 1] 3 [CLINIC 2] 4 [CLINIC 3] 19. In the last 12 months, did you 5 [CLINIC 4] want your primary doctor or nurse’s help in 6 [CLINIC 5] making changes in your habits or lifestyle 7 Another clinic to prevent illness? Please 1 Yes 2 No 15. In the last 12 months, how many did you visit your primary doctor or nurse to In the last 12 months, did your primary 20. get care for yourself? doctor or nurse encourage you to talk about your health concerns, including those that None If None, go to #29 on page 6 might be embarrassing? 1 time 1 Yes 2 2 No 3 4 In the last 12 months, did you and your 21. 5 to 9 primary doctor or nurse talk about how to 10 or more times maintain a healthy diet and healthy eating habits? 16. In the last 12 months, did your primary 1 Yes doctor or nurse suggest that you see a 2 No specialist for a health problem? 1 Yes In the last 12 months, did you and your 22. 2 No If No, go to #18 primary doctor or nurse talk about the exercise or physical activity you get? 17. In the last 12 months, how often did your 1 Yes primary doctor or nurse seem informed and 2 No up-to-date about the care you got from specialists? 23. In the last 12 months, did you and your 1 Never primary doctor or nurse talk about things in 2 Sometimes your life that worry you or cause you 3 Usually stress? 4 Always 1 Yes 2 No
14. one of the following clinics do you go to when you see your primary doctor or nurse? 1 [CLINIC 1] 3 [CLINIC 2] 4 [CLINIC 3] 5 [CLINIC 4] 6 [CLINIC 5] 7 Another clinic Please 15. In the last 12 months, how many did you visit your primary doctor or nurse to get care for yourself? None If None, go to #29 on page 6 1 time 2 3 4 5 to 9 10 or more times 16. In the last 12 months, did your primary doctor or nurse suggest that you see a specialist for a health problem? 1 Yes 2 No If No, go to #18 17. In the last 12 months, how often did your primary doctor or nurse seem informed and up-to-date about the care you got from specialists? 1 Never 2 Sometimes 3 Usually 4 Always 18. In the last 12 months, did you and your primary doctor or nurse talk about specific things you could do to prevent illness? 1 Yes 2 No 19. In the last 12 months, did you want your primary doctor or nurse’s help in making changes in your habits or lifestyle to prevent illness? 1 Yes 2 No 20. In the last 12 months, did your primary doctor or nurse encourage you to talk about your health concerns, including those that might be embarrassing? 1 Yes 2 No 21. In the last 12 months, did you and your primary doctor or nurse talk about how to maintain a healthy diet and healthy eating habits? 1 Yes 2 No 22. In the last 12 months, did you and your primary doctor or nurse talk about the exercise or physical activity you get? 1 Yes 2 No 23. In the last 12 months, did you and your primary doctor or nurse talk about things in your life that worry you or cause you stress? 1 Yes 2 No
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