This is an example Emergency Room Visit survey. This survey includes questions like:
Are you male or female
What is your age?
Do you have health insurance?
We hope this will help you create your own Emergency Room Visit survey. We
have not tested the validitiy or reliability of this survey. However, you may
use this as a starting point to help your own survey instrument. Feel free to
change and edit any of our survey templates to help you get started.