Take our Survey

Would You Like to Discuss Your Condition With Dr La Puma?

Please take our quick, easy survey on the services we may provide.

1) How likely would you be to use an electronic private pay "Discussion" option with Dr. La Puma? Note: Discussion is not a medical consultation.

	Unlikely
	Somewhat unlikely
	Unsure
	Somewhat likely
	Likely

Other, please specify

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2) If Unsure, Likely or Somewhat Likely, which type of discussion would you like to use?

	Telephone
	Skype, video
	Skype, no video
	E-Mail
	Name service here

Other, please specify

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3) What would be the most important factor about determining whether to have such a discussion? (e.g., cost, ease, accountability, structure, anticipated clinical success, personalness of care, other...)

4) Which topics would you like to discuss with Dr La Puma?

	Your Weight
	Your Cholesterol
	Your Triglycerides
	Your Heart Problems
	Your Medication and Supplements
	A Family Member's Problems
	None of the Above: Write In Below

Other, please specify

Comments

5) If you had weekly discussions for weight control with Dr La Puma, how long should they last?

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