Medical Services Used at Hospital or Other Medical Facility Past 3 Years*
Any Overnight Stay Procedure
Cancer/Oncology
Cardiac Care
Cosmetic/Reconstructive Surgery
Laser Eye Surgery
LASIK Eye Surgery
Maternity Care
Mental Health Care
Neurology
Non-Surgical Cosmetic Dentistry
  (Teeth Whitening, Veneers, etc.)
Orthopedics
Pediatrics
Other Medical Services

Healthcare Specialists Used Past 12 Months
Cardiologist
Chiropractor
Dentist
Dermatologist (Skin Doctor)
Fee Paid Weight Loss
Ophthalmologist (Eye Doctor)
Optometrist (Eye Examiner)
Plastic/Cosmetic Surgeon
Podiatrist (Foot Doctor)
Other Specialist

Stores Bought Glasses or Contacts Past 12 Months

Household Members Who Wear Glasses or Contact Lenses

Hospitals Used*
Past 3 Years
Preferred

Pharmaceuticals
Places Purchasesd Prescription Drugs/
  Other Medication/Health/Beauty Items
  Past 30 Days

Reasons Bought Medications Past 12 Months
Allergies
Arthritis
Asthma
Children's Medicine
Cholesterol
Cold or Flu
Diabetes
Digestive Disorder
High Blood Pressure
Impotence
Quit Smoking
Weight Loss
Other

Planning to Shop For Next 12 Months*
Nursing/Convalescent Services
  or Retirement Facility

Health Insurance Provider
Type
Insurance Company
     Group
     Individual

Life Insurance

Belong to a Healthclub

*Household Measurements