SEEK - Health Status Questionnaire

This comprehensive 45-question survey, designed as a baseline record for new Medicare-aged health plan members, covers:

  • Activities of daily living
  • Health conditions
  • Health promotion
  • Prior heath care utilization
  • Sociodemographics

The three-step survey process, including an initial form, reminder postcard, and final form to non-respondents, uses a customized cover letter (based on minimum order) and envelopes to improve recognition. HSQ software and instruction booklet are provided to load, report, and query member response information. Data is sent to your organization weekly for one year after each initial mailing.

Services with mailed surveys

  • Address changes and termination information
  • Consulting services
  • Frailty and risk of hospital re-admission calculation
  • Microsoft Access®-based Software
  • Points of interest for healthy aging
  • Postcard reminder
  • Secure Web file transfer
  • Spanish and Chinese HSQs available upon request
  • Summary sheet



Use the Inquiry Form (PDF format) or email: for pricing information. Costs depend on the quantity ordered and level of customization desired. The price includes survey mailing, data collection, and a customized database.

Download Inquiry Form