GenAI_Survey_Test_V1

GenAI_Survey_Test_V1_Test

Take the Survey

1. How would you rate the overall quality of healthcare services available to you? (required)

Excellent

Good

Poor

2. How concerned are you about the cost of healthcare? (required)

Very concerned

Not concerned

First Name

Last Name

Landline Phone

Mobile Phone

Email Address

Zip Code

Yes, I want to Volunteer

Password (at least 8 characters)