1. Please enter e-mail address E-mail 2. Gender: male female 3. Age less than 20 21 - 30 31 - 40 41 - 50 51 - 60 61 - 70 more than 70 4. enter ZIP code if you live in the United States ZIP code 5. please select a Country Select One ALBANIA ALGERIA AMERICAN SAMOA ANGOLA ANGUILLA ANTIGUA & BARBUDA ARGENTINA ARMENIA ARUBA ASCENSION ISLAND AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOPHUTHATSWANA BOSNIA/HERZEGOVINA BOTSWANA BRAZIL BRITISH VIRGIN ISLANDS BRUNEI BULGARIA BURKINA FASO BURMA BURUNDI BYLELARUS CAMBODIA CAMEROON CANADA CAPE VERDE ISLANDS CAYMAN ISLANDS CHAD CHANNEL ISLANDS CHILE CHINA, PEOPLE'S REPUBLIC OF CHRISTMAS ISLAND COCOS KEELING ISLANDS COLOMBIA COMOROS CONGO, PEOPLE'S REPUBLIC OF THE COOK ISLANDS COSTA RICA CROATIA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI, REPUBLIC OF DOMINICA DOMINICAN REPUBLIC EAST TIMOR ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ETHIOPIA ESTONIA FAEROE ISLANDS FALKLAND ISLANDS FIJI ISLANDS FINLAND FRANCE FRENCH ANTILLES FRENCH GUIANA FRENCH POLYNESIA GABON REPUBLIC GAMBIA GEORGIA, REPUBLIC OF GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUANTANAMO BAY GUATEMALA GUINEA, PEOPLE'S REV. REPUBLIC GUYANA HAITI HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRELAND ISLE OF MAN ISRAEL ITALY IVORY COAST JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LATVIA LEBANON LESOTHO LIBERIA LIBYAN JAMAHARIJA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA MADAGASCAR MALAWI MALAYSIA MALDIVES, REPUBLIC OF MALI REPUBLIC MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE ISLANDS MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEVIS NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER REPUBLIC NIGERIA NIUE NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN ISLAND POLAND PORTUGAL QATAR REUNION ISLAND ROMANIA RUSSIA SAN MARINO SAO TOME & PRINCIPE SAUDI ARABIA SENEGAL REPUBLIC SERBIA/MONTENEGRO SEYCHELLES ISLANDS SIERRA LEONE SINGAPORE SLOVAK REPUBLIC SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH KOREA SOUTH MARIANA ISLANDS SOUTH VIETNAM SPAIN SRI LANKA ST. HELENA ST. KITTS & NEVIS ST. LUCIA ST. PIERRE/MIQUELON ST. VINCENT & GRENADINES SURINAME SWAZILAND SWEDEN SWITZERLAND TAHITI TAIWAN TAJIKISTAN TANZANIA THAILAND TOGO, REPUBLIC OF TOKELAU TONGA ISLANDS TRINIDAD & TOBAGO TRISTAN da CUNHA TURKEY TURKMENISTAN TURKS & CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM URUGUAY U.S.A. UZBEKISTAN VANUATU VATICAN CITY VENEZUELA WALLIS & FUTUNA WESTERN SAMOA YUGOSLAVIA ZAIRE, REPUBLIC OF ZAMBIA ZIMBABWE 6. Education level Grammar School High School Some technical training College 4-year degree Masters degree Doctoral degree Professional degree 7. Connection Speed 9.6 Kbps or less 14.4 Kbps 28.8 Kbps 33.6 Kbps 56.2 Kbps ISDN T1 or greater I dont know 8. You are calling from: Home Office Friend’s computer Other 9. How did you learn about this site? link search engine your doctor 10. How did you find your surgeon? Referral from another doctor Advertisement word of mouth Internet My health plan provides me with a doctor I dont have a doctor yet 11. Have you already had laparoscopic surgery? NO (go to Question 13) Yes, had my gallbladder removed Yes, had “tubal ligation” Yes, had spleen removed Yes, had colon removed Yes, had anti-reflux procedure for “heartburn” Yes, had other gynecology procedure Yes, had other laparoscopy procedure 12. Are you happy with the outcome of the procedure? yes more or less No 13. Why did you consult the Internet for medical/surgical information? Wanted more information about my disease My physician’s explanation needed clarification Privacy issues Convenience of time and access of internet information 14. Do you trust medical information you retrieve on the Internet?(check all that apply) No, I dont trust it I am not sure I trust the Internet more than my family doctor yes, because of the site's sponsors Yes, due to credentials of physicians and cited studies Yes, due to the clarity of the material presented Yes, due to presence of links for further information I don't have anywhere else to turn for medical information I have never used the Internet prior to this time 15. Would you be interested in ON-LINE real time consultation? yes No I dont know 16. How would you rate this site? Not very useful useful very useful Thank you for taking the time to complete this survey. Select Submit Survey now to send your responses to us.
1. Please enter e-mail address
E-mail
2. Gender:
male female
3. Age
less than 20 21 - 30 31 - 40 41 - 50 51 - 60 61 - 70 more than 70
4. enter ZIP code if you live in the United States
ZIP code
5. please select a Country
Select One ALBANIA ALGERIA AMERICAN SAMOA ANGOLA ANGUILLA ANTIGUA & BARBUDA ARGENTINA ARMENIA ARUBA ASCENSION ISLAND AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOPHUTHATSWANA BOSNIA/HERZEGOVINA BOTSWANA BRAZIL BRITISH VIRGIN ISLANDS BRUNEI BULGARIA BURKINA FASO BURMA BURUNDI BYLELARUS CAMBODIA CAMEROON CANADA CAPE VERDE ISLANDS CAYMAN ISLANDS CHAD CHANNEL ISLANDS CHILE CHINA, PEOPLE'S REPUBLIC OF CHRISTMAS ISLAND COCOS KEELING ISLANDS COLOMBIA COMOROS CONGO, PEOPLE'S REPUBLIC OF THE COOK ISLANDS COSTA RICA CROATIA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI, REPUBLIC OF DOMINICA DOMINICAN REPUBLIC EAST TIMOR ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ETHIOPIA ESTONIA FAEROE ISLANDS FALKLAND ISLANDS FIJI ISLANDS FINLAND FRANCE FRENCH ANTILLES FRENCH GUIANA FRENCH POLYNESIA GABON REPUBLIC GAMBIA GEORGIA, REPUBLIC OF GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUANTANAMO BAY GUATEMALA GUINEA, PEOPLE'S REV. REPUBLIC GUYANA HAITI HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRELAND ISLE OF MAN ISRAEL ITALY IVORY COAST JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LATVIA LEBANON LESOTHO LIBERIA LIBYAN JAMAHARIJA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA MADAGASCAR MALAWI MALAYSIA MALDIVES, REPUBLIC OF MALI REPUBLIC MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE ISLANDS MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEVIS NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER REPUBLIC NIGERIA NIUE NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN ISLAND POLAND PORTUGAL QATAR REUNION ISLAND ROMANIA RUSSIA SAN MARINO SAO TOME & PRINCIPE SAUDI ARABIA SENEGAL REPUBLIC SERBIA/MONTENEGRO SEYCHELLES ISLANDS SIERRA LEONE SINGAPORE SLOVAK REPUBLIC SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH KOREA SOUTH MARIANA ISLANDS SOUTH VIETNAM SPAIN SRI LANKA ST. HELENA ST. KITTS & NEVIS ST. LUCIA ST. PIERRE/MIQUELON ST. VINCENT & GRENADINES SURINAME SWAZILAND SWEDEN SWITZERLAND TAHITI TAIWAN TAJIKISTAN TANZANIA THAILAND TOGO, REPUBLIC OF TOKELAU TONGA ISLANDS TRINIDAD & TOBAGO TRISTAN da CUNHA TURKEY TURKMENISTAN TURKS & CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM URUGUAY U.S.A. UZBEKISTAN VANUATU VATICAN CITY VENEZUELA WALLIS & FUTUNA WESTERN SAMOA YUGOSLAVIA ZAIRE, REPUBLIC OF ZAMBIA ZIMBABWE
6. Education level
Grammar School High School Some technical training College 4-year degree Masters degree Doctoral degree Professional degree
7. Connection Speed
9.6 Kbps or less 14.4 Kbps 28.8 Kbps 33.6 Kbps 56.2 Kbps ISDN T1 or greater I dont know
8. You are calling from:
Home Office Friend’s computer Other
9. How did you learn about this site?
link search engine your doctor
10. How did you find your surgeon?
Referral from another doctor Advertisement word of mouth Internet My health plan provides me with a doctor I dont have a doctor yet
11. Have you already had laparoscopic surgery?
NO (go to Question 13) Yes, had my gallbladder removed Yes, had “tubal ligation” Yes, had spleen removed Yes, had colon removed Yes, had anti-reflux procedure for “heartburn” Yes, had other gynecology procedure Yes, had other laparoscopy procedure
12. Are you happy with the outcome of the procedure?
yes more or less No
13. Why did you consult the Internet for medical/surgical information? Wanted more information about my disease My physician’s explanation needed clarification Privacy issues Convenience of time and access of internet information 14. Do you trust medical information you retrieve on the Internet?(check all that apply) No, I dont trust it I am not sure I trust the Internet more than my family doctor yes, because of the site's sponsors Yes, due to credentials of physicians and cited studies Yes, due to the clarity of the material presented Yes, due to presence of links for further information I don't have anywhere else to turn for medical information I have never used the Internet prior to this time 15. Would you be interested in ON-LINE real time consultation? yes No I dont know 16. How would you rate this site? Not very useful useful very useful Thank you for taking the time to complete this survey. Select Submit Survey now to send your responses to us.
Wanted more information about my disease My physician’s explanation needed clarification Privacy issues Convenience of time and access of internet information
14. Do you trust medical information you retrieve on the Internet?(check all that apply)
No, I dont trust it I am not sure I trust the Internet more than my family doctor yes, because of the site's sponsors Yes, due to credentials of physicians and cited studies Yes, due to the clarity of the material presented Yes, due to presence of links for further information I don't have anywhere else to turn for medical information I have never used the Internet prior to this time
15. Would you be interested in ON-LINE real time consultation?
yes No I dont know
16. How would you rate this site?
Not very useful useful very useful
Thank you for taking the time to complete this survey. Select Submit Survey now to send your responses to us.
