1. Based on current information, are you concerned about acquiring SARS?
Yes
No
Not Sure
2. In what country do you currently reside?
3. Has the SARS issue affected your personal or business travel plans?
Yes
No
I currently do not have any reason to travel
4. Do you believe the media are reporting the facts accurately and in a responsible manner?
Yes
No
Not Sure
5. What is your age?
6. What is your gender?
7. Are you covered by health insurance?
Yes
No
8. Do you pay for it yourself or is it paid by an employer?
Paid by me
Paid by employer
Other
9. If you require medical attention, do you go to a :
Clinic setting
Hospital emergency Dept.
Personal Physician
Other
10. What is your level of education? Check all that apply.
Grammer School
High School
Some College
College Graduate
Post Graduate
