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Costanoan Rumsen Carmel Tribe
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Los Angeles County Indian Health Services |
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| Which of the following make it difficult for you to get medical care? (Check all that apply) | |
| 1. No insurance | |
| 2. No/low income | |
| 3. Distance | |
| 4. Transportation | |
| Which problems have you encountered when seeking care? (Check all that apply) | |
| 1.Distance | |
| 2. No/low income | |
| 3. Did not qualify for services | |
| 4. Did not live in the covered area | |
| 5. Not in a covered tribe | |
| 6. Long waiting lists | |
| 7. No indian clinic in L.A County/area | |
| 8. Uncomfortable with the treatment/reception that you reveived | |
| 9. Culturally insensitive | |
| What are your medical needs? (Check all that apply) | ||
| 1. Health check-ups for self | ||
| 2. Health check-ups for other adult household members | ||
| 3. Health check-ups for childern | ||
| 4. Immunizations | ||
| 5. Filling prescriptions | ||
| 6. X-rays | ||
| 7. Orthodontics (braces) | ||
| 8. Dental care | ||
| 9. Optometry (eyes) | ||
| 10. OB/Gyn services | ||
| 11. Behavioral/Mental health | ||
| 12. Orthopedics (bones, muscles,nerves, etc | ||
| 13. Senior health and home care | ||
| 14. Drug/Alcohol Rehab | ||
| 15. Podiatry (Feet) | ||
| 16. Family Planning/ STD treatment | ||
| 17. Family abuse intervention programs | ||
| 18. Physical Therapy | ||
| 19. Dermatology (skin, hair, etc.) | ||
| 20. Diabetes | ||
| 21. Other | ||
| Would you be willing to continue helping us to get this medical clinic started by filing out our surveys or giving additional information? |
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Yes No |