Shady Grove Fertility Center Survey
1.

My Age Is...
25-30
31-35
36-40
41-45
46+
2.

My Ethnicity Is...
Caucasian
African-American
Hispanic
Asian
Middle Eastern
Other  
3.

I Live In...
DC Metro Area
Baltimore Metro Area
Maryland Suburbs
Virginia Suburbs
Outside Washington DC, Maryland and Virginia
Outside the United States
4.

My Shady Grove Fertility Office Location Is...
Annandale, VA
Annapolis, MD
Baltimore, MD - GBMC
Baltimore, MD - University of Maryland
Bel Air, MD
Columbia, MD
Fair Oaks, VA
Frederick, MD
Leesburg, VA
Rockville, MD
Washington, DC
Woodbridge, VA
5.

My Education Level Is...
High School
College
Graduate School or Equivalent
6.

Years Trying To Conceive...
< 1 Year
1-2 Years
2-5 Years
5 Years or Longer
Have Conceived or Already Have a Baby
7.

My Income Level Is...
< $50,000
$50,000 - $75,000
$76,000 - $100,000
$101,000 - $150,000
Over $150,000
8.

My Insurance Provided...
Full Infertility Benefits
Some Infertility Benefits
Fertility Medication Benefits Only
Neither Infertility Nor Medication Benefits
Other  
9.

The Following SGFC Programs Helped / Is Helping Me...
Insurance Participation
Fertility Financing
Shared Help Fertility Discount Treatment Program
Shared Risk 100% Refund Program
Shared Donor Egg Program