The Wake Forest Baptist Health Panel is an online community designed to improve the health care experience in the Piedmont Triad and surrounding communities. The Panel is open to people from all walks of life; we want to hear from both Wake Forest Baptist Health patients and patients of other health care systems. There are a few questions we need you to answer before you can join the Panel.



Which of the following statements best describes you?

When we say 'patient' we mean you have visited a health care facility in the last 2 years.


I am a patient of the Wake Forest Baptist Health system only.
I am a patient of the Wake Forest Baptist Health system and another health care system(s).
I am not a patient of Wake Forest Baptist Health but I am a patient of another health care system(s).
I do not consider myself to be a patient of any particular health care system.

Are you or were you a student of Wake Forest University?

I am currently a WFU student
I am a former WFU student
I am not and have not been a WFU student

Please enter the zip code of your primary residence:

   

What is your age?



What is your gender?

Male
Female

What is the primary language you speak in the household?

English
Spanish
Other 

Do you or does anyone living in your home currently work for a/an...?

Grocery store or food services company
Advertising agency
Manufacturer of consumer packaged goods
Retail store or mass merchandiser
Market research company
Health care provider, hospital, clinic, nursing home or other facility, including EMS
Government organization
A financial institution such a bank or brokerage firm
None of these
Please do not use the next or back button on your browser while you take this survey.