Form FSR 181 DOD TRICAR FSR 181 DOD TRICAR FSR 181 DOD TRICARE

TRICARE Custom Questions
How frequently do you visit our site?	First time
	Every 6 months or less
	About once a month
	About once a week
	Daily
	More than once a day
Which of the following best describes your role in visiting our site today?	TRICARE beneficiary
	Family, friend or caregiver of TRICARE beneficiary
	Future TRICARE beneficiary
	TRICARE Network Provider or Provider Staff
	TRICARE Non-Network Provider or Provider Staff
	Prospective TRICARE Provider or Provider Staff
	Military Treatment Facility Clinical Staff
	TRICARE Beneficiary Advisors and Customer Service Staff
	All other Military Health System/TRICARE staff (Including government and supporting contractors)
	Media/Researcher
	Other
For TRICARE beneficiaries only- which best describes your status?	Active Duty Sponsor
	Active Duty Family Member
	Retired Sponsor
	Family Member of Retired Sponsor
	National Guard or Reserve
	Family Member of National Guard or Reserve
	Other Beneficiary
	Not Applicable
Which of the following best describes your main reason for visiting our Web site today?	Find out what’s covered
	Look up costs
	Find a civilian/network provider
	Find a military provider
	Make an appointment
	Look up a toll free phone number
	File a claim
	Check the status of a claim
	Problem with a claim
	Enroll
	Pay Enrollment Fees
	Check eligibility
	Update personal information
	Learn about the plans / options
	Look up health information / medical advice
	Other (please explain)
Where did you first go to find this information?	This web site was the first place I went
	I went to a different Web site
	I called a toll-free number
	I read a TRICARE brochure or handbook
	I visited a TRICARE Service Center
	I visited a Military Treatment Facility
	Other (please explain)
If you did not find what you were looking for, what will you do now?	Try a different Web site
	Call a toll-free number
	Read a TRICARE brochure or handbook
	Visit a TRICARE Service Center
	Visit a Military Treatment Facility
	Other (please explain)
	Not applicable
If you did not find what you were looking for on our Web site, what was it?
For TRICARE beneficiaries only: which of the following best describes your TRICARE enrollment option?	Sponsor is active duty (no premium paid)
	Sponsor is active duty and family member has disenrolled from Prime to use TRICARE Standard
	Sponsor is retired and we pay either $230/individual or $460/family per year
	Sponsor is retired and we pay the Medicare Part B premium; TRICARE for Life
	Sponsor is retired (and we do NOT pay either a TRICARE or Medicare Part B premium; TRICARE Standard)
	Not applicable
For TRICARE beneficiaries only- do you receive most of your care from:	A military clinic or hospital
	A civilian clinic or hospital
	Not applicable
What method are you using to locate the information you are looking for?	Search Bar
	Clicking buttons
	By entering Zip Code
	By clicking on Map
	By "Jump To" or “A to Z”
	TRICARE Factsheets
	Site Map
	Other
How did you get to our Web site today?	Referred by TRICARE brochure or handbook
	Referred by TRICARE customer service representative
	Typed in the address
	Search engine (such as Google or Yahoo)
	Bookmarks or Favorites
	Link from another Web site
	Other
If you could make one improvement to the site what would that be?
What is your gender?	Male
	Female
What is your age?	Less than 18
	18 to 24
	25 to 34
	35 to 44
	45 to 64
	65 and better
Where are you located?	US (Continental)
	Alaska
	Hawaii
	Pacific
	Latin America
	Canada
	Europe
	Puerto Rico/Virgin Islands
	Other Overseas
Have you done any of the following activities in the past 90 days?	Applied for a job online
	Listed an item to sell in an online auction or online classified ad
	Made a purchase online
	Managed personal finances online
	Researched a major purchase item online
	None of these