Hepatitis C Awareness USA Today Supplement Survey
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USA Today/Hepatitis C Awareness Survey

We'd like to know if the Hepatitis C Awareness report in USA Today was helpful to you. Please fill out the following confidential survey. We appreciate your feedback.
 
1. Have you ever been tested for hepatitis C?
Yes
No
I don't know
 
2. How likely are you to be tested or to encourage others to be tested for hepatitis C?
Definitely likely
Somewhat likely
Not likely
 
3. How important is it to know if you've been infected with the hepatitis C virus?
Very important
Somewhat important
Not at all important
 
4. Has your understanding of the risk factors for hepatitis C...
Increased greatly
Increased slightly
Stayed the same
 
5. Has your understanding of the treatment options for hepatitis C...
Increased greatly
Increased slightly
Stayed the same
 
6. How comfortable are you talking to your health care provider about personal issues, like your sexual behavior or recreational drug use?
Very comfortable
Somewhat comfortable
Not at all comfortable
 
7. Have you ever been diagnosed with any of the following? (Check all that apply.)
Hepatitis A
Chronic hepatitis B
Other forms of liver disease
HIV/AIDS
 
8. What is your gender?
Male
Female
Transgender
Other
 
9. What is your sexual orientation?
Straight/Heterosexual
Gay/Lesbian
Bisexual
Other
 
10. What year were you born?
 
11. What is your ethnicity? (Check all that apply.)
American Indian or Alaska Native
Arab or Middle Eastern
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
White
(please specify) 
 
12. What is your ZIP code?
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