Prospective Member Survey

  1. Are you aware of the political accomplishments of CNH?
     Yes
     No

  2. CNH is looking for ways to increase and expand member services. Please indicate your level of interest in having CNH offer the following services. In your opinion, does the following list of services have a high, medium, or low level of appeal to you?

    Professional Liability Insurance High Medium Low
    Long Distance Service High Medium Low
    Disability Income Insurance High Medium Low
    Overnight Delivery Service High Medium Low
    Group Health Insurance High Medium Low
    Discounted Office Equipment High Medium Low
    Discounted Credit Card Processing High Medium Low
    Member’s Only Credit Card High Medium Low
    Discounted Vision Care High Medium Low
    Discounted Prescription Drugs High Medium Low
    Discounted Dental Services High Medium Low
    Discounted Chiropractic Services High Medium Low
    Discounted Fitness, Health Supplies & Equipment   High Medium Low
    Bargain Book Rates High Medium Low
    Discounted Flowers & Gift Baskets High Medium Low
    Car Pricing, Purchasing & Referral Service High Medium Low
    College Education Program High Medium Low
    Amusements Park Discounts High Medium Low
    Discounted Dining Program High Medium Low
    Sam’s Club Membership High Medium Low
    Discount on Air Travel High Medium Low
    Grocery Store Coupons High Medium Low
    Tax Preparation Services High Medium Low

  3. Do you currently own or operate a business that involves naturopathy or any of its component modalities?
     Yes
     No

  4. Is your naturopathic business:
     Solo Practice
     Group Practice
     Clinic/Private
     Clinic/Public
     Other

  5. How would you describe the community where you live?
     Suburban
     Medium Town
     Small Town
     Rural
     NA

  6. Which category best describes the percentage of your household income from naturopathy?
     Under $10,000
     $10,000 - $15,000
     $15,000 - $25,000
     $25,000 - $35,000
     $35,000 - $45,000
     $45,000 - $55,000
     $55,000 - $75,000
     $75,000 and over
     NA

  7. Which degrees in natural health do you currently have?
     B.S. in Natural Health
     M.S. in Natural Health
     Doctor of Naturopathy or ND
     Ph.D. in Natural Health
     Ph.D in Holistic Health Sciences
     Other — Please Specify:

  8. Where did you obtain your holistic health degree?
     Westbrook University
     Bastyr University
     Trinity School of Natural Health
     Hallmark School of Natural Healing
     Clayton College of Natural Health
     Barrington University
     The Herbal Healer Academy
     Other — Please Specify:

  9. Would you like to learn more about membership with the Coalition for Natural Health?
    Yes
    No

    Please provide your contact information below:

    Name
    Address
    Suite/Apt
    City
    State Zip
    E-mail
    Phone