HEDR Annual Survey

Source
We encourage you to complete this survey so that Medicare can best serve your healthcare needs. As a reminder, you remain eligible to receive the same Medicare benefits and you still have the right to use any doctor, other health care professional, or hospital that accepts Medicare, at any time.
Please provide the survey Id found on your letter.*
Do you want to continue taking the survey?*

YesNo, I decline
Thank you. Please click "Submit" to exit the survey.
Sex Assigned at Birth
Preferred Language
Race
Ethnicity
Would you be willing to answer some additional questions?

YesNo
If you selected "No" in the question above the survey will end. If you selected "Yes" you will continue the survey.
If you have questions, feel free to ask your doctor or other health care professional, call Vytalize Health at 1-844-570-1010, or call Medicare at 1-800-MEDICARE (1-800-633-4227) to ask about ACOs. TTY users should call 1-877-486-2048.
Survey ID
Preferred Language

EnglishAmharicArabicArmenianBengaliCambodian (Khmer)ChineseFarsiFrenchGermanGreekGujaratiHaitian CreoleHindiHmongItalianJapaneseKoreanLaotianPhilippinesPolishPortugueseRussianSamoanSpanishVietnameseOther
Date of Birth

YearMonthDay
Date of Birth
Last Name
First Name
Survey Id
Race

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteUnknownChoose Not to DiscloseOther
Sex Assigned at Birth*

MaleFemaleUnknown
Ethnicity

Hispanic or LatinoNot Hispanic or LatinoChoose Not to DiscloseUnknownOther
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