2010 Asthma Disease Management Satisfaction Survey - (copy)

Annual written questionnaire of asthma DM participants on their satisfaction with the program.

Name


  1. I understood the materials about asthma.
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Does Not Apply


  1. The materials helped me/my child better control his or her asthma.
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Does Not Apply


  1. I/my child have been able to do things to help control my/my child's asthma.
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Does Not Apply


  1. I am happy with "L.A. Cares About Asthma"
    Strongly Agree
    Agree
    Disagree
    Strongly Agree
    Does not apply


  1. I have had a flu shot between September 1, 2008 through March 31, 2009.
    Yes
    No


  1. I/my child has had a pneumonia shot.
    Yes
    No


  1. I/my child have an asthma action plan.
    Yes
    No


  1. I/my child have talked with the doctor about the asthma action plan.
    Yes
    No


  1. I/my child would like to learn more about these asthma topics:


  1. Name:


  1. Address


  1. City and Zip Code


  1. Phone Number


  1. Cell Phone Number


  1. Date of Birth


  1. Email Address





L. A. Care Health Plan
Los Angeles, CA