Social Determinants Screening Survey 2024

Please take five to ten minutes to answer these questions.

Answer as many questions as you can. If a question does not apply to you, feel free to skip and move onto the next question. Based on the answers you provide, a Priority Health team member may contact you with additional resources.

Please note, by beginning this survey, you will be sharing your answers with us. We collect responses for all partially completed surveys, even those that are not submitted.

Your answers are confidential and will not impact your plan benefits or services. Personal information is collected for verification purposes only.

1. Member First Name

2. Member Last Name

3. County *This question is required.

4. Member Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

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5. Member Contract ID *This question is required. Please provide the number on your membership card (not the primary subscribers card).
Please include all numbers and dashes and confirm accuracy.

6. Member Email Address This question requires a valid email address.