Complementary and Alternative Medicine Questionnaire

Thank you for taking the time to complete this questionnaire. The questionnaire is designed to
examine use of complementary/alternative health therapies.

Complementary/alternative medicine (or CAM) is defi ned as any natural health products (example,
herbal products, vitamins, minerals, traditional Chinese medicine) or therapies (example, acupuncture,
naturopathy, homeopathy, chiropractic manipulation, yoga, refl exology) you use or have used that were
NOT suggested by a medical doctor.


Part A: Information about you
Please respond to the following questions.

What is your age:

Sex:

What grade have you completed?

What cultural traditions infl uence your decisions about health care? (Check all that apply)

In general, would you say your health is:

Part B: Therapies and providers that you have used

Have you used complementary/alternative medicine (CAM) for: (Check all that apply)

Identify the statement that best describes your health care practices:

Which natural health products and therapies do you use or have you used in the past? (Check all that apply):

New Identify the statement that best describes your intake of natural health products. A natural health product includes vitamins and minerals. (Check only one box)

Identify the statement that best describes your level of involvement with a CAM provider. (Check only one box)