AFAN Insurance Gap Initiative - Survey

Thank you for responding to AFAN's insurance gap initiative survey. Please provide the following information. For confidentiality, please do not provide your name.

If you would prefer to print a paper version of the survey and send it via traditional mail, you can download a copy here. (You will need the free Adobe Reader to view and print the file.)

Geographical area:
United States   
Specify state
Canada
United Kingdom
Australia
Other   
Please specify

Age:

Do you work as a paid astrologer?
  Full time
  Part time
  No

Current health status:
Please describe, especially as it relates to ongoing health care costs.

Current health care coverage:
Your own, spouse, other employer, subsidy, Medicare/Medicaid, combination

Estimate of monthly health care costs:
Doctor visits, prescriptions, premiums on coverage

Have you had any hospitalizations, surgery or diagnostic testing in the past year?
Please specify:

Do you anticipate any hospitalizations, surgery or diagnostic testing in the upcoming year?
Please specify:

Have you ever experienced a loss of income due to health issues or an accident?
Describe briefly, including estimate of loss, if possible

Have you ever been significantly impacted financially because of lack of health coverage?
Please describe, including amount(s) if possible

Are you currently experiencing financial difficulty or health crises due to lack of health insurance coverage?
Please explain

Do you have any relevant resources specific to your state, country or region that could be helpful to other AFAN members who are professional astrologers? Would you be interested in assisting with this project?

Press the "Continue" button to verify your information before sending it.