2010 Student Health and Dental Plan Survey
Put in your Word and have your voice Heard!
Support the Survey

GENERAL INFORMATION
1: What is your Faculty and Year of study?
 Arts 1st
Science & Technology 2nd
Business & Prof. Studies 3rd
Tourism & Outdoor Rec.  4th
Health & Education 5th
Fine & Applied Arts
Preparatory Studies

2: What type of tuition fees do you pay?
 Domestic
International

3: Please indicate your gender.
 Male
Female

EXTENDED HEALTH INFORMATION
An extended health care plan (i.e. Blue Cross) covers some or all of your medical costs not covered by your provincial health care plan, such as prescription drugs, ambulance service, paramedical services, travel insurance, etc.
4: When was the last time you visited any of the following: Walk-in Clinic, Hospital Emergency room, Doctors Office?
 0-6 months
6-12 months
1-2 years
2-3 years
3+ years

5: Do you have an extended health care plan in addition to your provincial health care plan?
 Yes, with parents
Yes, with spouse/partner
Yes, with employer
No
Unsure

6: Please indicate if you have visited any of the following practitioners in the past twelve months. Please check all that apply.
 Chiropractor
Physiotherapist
Massage Therapist
Naturopath
Psychologist
Not Applicable

7: Have you had any prescriptions written for you by a doctor in the past year?
Yes
No

8: Would you be in favour of the Capilano Students’ Union implementing a health plan that would provide most full time students with extended health benefits at a cost of $89 per year?

Students with alternative coverage may choose to opt out from the plan.

 Yes
No

EXTENDED DENTAL PLAN INFORMATION
A dental care plan (i.e. Blue Cross) covers some or all of your costs for dental services and treatments, such as exams, x-rays, cleaning and polishing, fillings, extractions, etc.
9: When was the last time you visited a dentist’s office?
 0-6 months
6-12 months
1-2 years
2-3 years
3+ years

10: Do you have a dental care plan that covers some or all of your dental costs?
 Yes, with parents
Yes, with spouse/partner
Yes, with employer
No
Unsure

11: Would you be in favour of the Capilano Students’ Union implementing a dental plan that would provide most full time students with dental benefits at a cost of $100 per year.

Students with alternative coverage may choose to opt out from the plan.

 Yes
No