VA Health Care Utilization Survey #1
Answers marked with a * are required.
 
1. Do you live in the Lehigh Valley (Lehigh or Northampton County) of Pennsylvania?
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2. Did you perform federal, active duty service in the U.S. Military?
*

      

 
 
 
3. Did you serve sometime after 7 October 2001 (the "Global War on Terrorism" period)?
*

      

 
 
 
4. Are you still on active duty status?
*


      

 
 
 
5. My age group is:
*





      

 
 
 
6. Are you enrolled in the VA Health Care system (You signed up to use it.)?
*

      

 
 
 
7. Is it your primary source of health care?
*





      

 
 
 
8. Are you drawing disability compensation or a pension from the VA (You receive a monthly check/deposit.)?

      

 
 
 
9. Do you have a disability rating for a service-connected injury?

      

 
 
 
10. My dependents use CHAMPVA (VA health care for dependents)?



      

 
 
 
 
 

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