S. I think you will especially like the Guide To Getting The Best Healthcare I want to deliver to you free right away as my way of thanking you for participating in this survey

Some potentially life-saving topics covered in this Guide include, “How to Avoid Deadly Medical Errors,” “How To Ask The Right Questions of Your Doctor,” “How To Make Sure You Are Getting the Very Best Treatment Available in the Event of a Medical Crisis,” “The 10 Things You Must Know Before You Visit Your Doctor,” and “How To Stay Informed of the Latest Medical Treatments and Breakthroughs That Can Save Your Life.”

As soon as I receive your completed survey, I will rush you this potentially life-saving Guide along with your free Special Report on What You Need to Know About Medicare.

I recommend that you not spend too much time thinking about each survey question. Your answers will be most helpful if they are your first instinctive response to each question. Completing this survey should only take you about six minutes.

Thank you so much for your help and participation in this important survey project that can change the way health care is delivered in America.

The Quality of Health Care in America National Research Survey

Conducted for the Benefit of Congress, the White House and the American People by Pinnacle Care International

Survey Registered To: Survey Due By:[xxxDatexxx]

xxxNamexxxxxxxxxx Your U.S. Representative:

xxxxxxAddressxxxxx xxxxxxxxxxxxxxxxxxxxxxxx

Your U.S. Senators:

xxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxx

IMPORTANT:

[Title/Last Name],

Please keep in mind that surveys received after [XXdateXX] might not be included in the survey report Pinnacle Care is submitting to Congress, the White House and leaders of the healthcare and health insurance industry.

Your individual answers will be held in the strictest confidence.

Your answers will not be shared with any other company, government agency, insurer or healthcare provider. Only the overall survey results will be made available to Congress, the White House and those who are setting healthcare policy in America. Your name, address, individual

answers and personal informat ion you supply in this survey will not be sold or distributed in any way.

All the information you supply here will remain confidential.

This survey will be analyzed and compiled by public opinion survey professionals so as to yield the most accurate results.

INSTRUCTONS:

Please read the questions and mark the answers that come closest to reflecting your views. The more questions you answer, the more helpful your survey will be in improving healthcare delivery in America and for you and your family. Please answer only the questions you’re able to answer. Thank you for participating.

1) Given that one out of every seven dollars earned in America is spent on healthcare, how satisfied are you with the overall quality of healthcare in America?

[ ] Very Satisfied [ ] Generally Satisfied [ ] Not Satisfied [ ] Undecided

2) How concerned are you about the overall quality of the healthcare you and/or your family are now receiving?

[ ] Very Concerned [ ] Concerned [ ] Not Concerned

3) Do you generally see the same doctor for you check-ups and treatments?

[ ] Yes, I have a doctor I like and trust [ ] I use a variety of doctors

[ ] I rarely see a doctor.

4) In general, would you like to see more government control and regulation or less government control and regulation over health care in America? Or would you like to leave it about as it is now?

[ ] Overall, I would like to see more government control and regulation of health care [ ] Overall, I would like to see less government control and regulation of health care [ ] I would leave it about as it is now

[ ] Not Sure

5) In general, who do you trust more to deliver healthcare in America, the government or insurance companies and healthcare providers (doctors, nurses, hospitals, clinics, HMOs, etc)?

[ ] I trust government more

[ ] I trust insurance companies and healthcare providers more [ ] I trust them about the same

6) It takes about [##] years for the Food and Drug Administration (FDA) to approve a new treatment or medicine.

In general, would you like to see the FDA approve new medicines and treatments more quickly? Or do you think the FDA is generally correct to be very cautious before allowing new medicines on the market, even if potentially life-saving?

[ ] I would like to see the Food and Drug Administration act faster in approving new, potentially life-saving medicines and treatments, even if we don’t know all the possible side-effects.

[ ] I think the FDA is right to be very cautious in approving new medicines and treatments, even if potentially life-saving. We need to understand all the possible side-effects.

[ ] I am undecided

7) How difficult do you find it to navigate the healthcare system today?

[ ] Very Difficult [ ] Difficult [ ] Not Difficult 8) How important to you is the Medicare program?

[ ] Absolutely Essential [ ] Very Important [ ] Important [ ] Not Important 9) Would you like to see Medicare transition into becoming more of a “means-tested” program for those who cannot afford private health coverage?

[ ] Yes [ ] No [ ] Undecided

10) Do you currently have health insurance?

11) Approximately how much do you spend each year on health insurance for you and your family?

About $___________ per year.

12) Approximately how much do you spend on medical care per year, excluding the health insurance premiums you might be paying?

About $____________ per year.

13) Approximately how much do you spend on vitamins and supplements each month?

About $________per month

14) Would you like to see Congress make all your medical, health insurance, and prescription drug costs tax-deductible?

[ ] Yes [ ] No [ ] Undecided

15) In your judgment, what is the overall condition of your health?

[ ] Excellent [ ] Good [ ] Fair [ ] Poor

16) Do you have any significant health issues or problems that concern you?

[ ] Yes [ ] No

If “Yes,” please describe in the space below.

[Put enough space to write answer here]

17) Are there any significant health issues or problems in your immediate family that especially concern you?

[ ] Yes [ ] No

If “Yes.” please describe in the space below.

[Put enough space here]

18) Approximately how many days per week do you exercise?

[ ] Three days or more per week [ ] About two days per week [ ] I exercise irregularly

[ ] I rarely exercise

19) When you exercise, do you focus more on aerobic exercise for your heart and cardiovascular system, or more on strength development, or a combination?

[ ] I focus more on aerobic exercise for my heart and cardiovascular system

[ ] I focus more on strength development, such as weights and muscle resistance machines [ ] I do both.

[ ] Other_______________________________________

[ ] I don’t exercise regularly

20) Do you subscribe to any health-related publications?

[ ] Yes [ ] No

If “Yes,” please list the health-related publication(s) you read in the space below:

[Put space to write here]

21) What is your height? ____________ 21) What is your weight?____________

22) In what range does your annual income fall in?

[ ] Under $20,000 per year [ ] Between $20,000 and $40,000 [ ] Between $40,000 and $60,000 [ ] Between $60,000 and $100,000 [ ] Between $100,000 and $200,000 [ ] Between $200,000 and $400,000 [ ] Over $400,000

23) What is your age range?

[ ] Under the age of 40 [ ] 40-50 [ ] 51-60 [ ] 61-70 [ ] 71-80 [ ] Over 80

24) How extensively do you travel?

[ ] Very extensively [ ] Frequently [ ] A few times a year [ ] About once a year [ ] Rarely 25) Are you a homeowner?

[ ] Yes [ ] No 26) Do you have a second home?

[ ] Yes [ ] No 27) What is your marital status?

[ ] Married [ ] Divorced [ ] Separated [ ] Widowed

If you are married, what is your the name of your spouse?_________________

28) Do you vote regularly in elections?

[ ] Yes [ ] No

29) What is your email address? ___________________________________ so you can receive your Guide To Getting The Best Healthcare, What You Need To Know About Medicare and other important reports from Pinnacle Care concerning new treatments and medical research

breakthroughs for treating life-threatening illnesses.

(Please print your email address clearly)

30) Day Phone____________________Night Phone________________ Mobil______________