Are you male or female?
Male Female

What is your age?
18-24 25-34 35-49 50-64 65 and over

What is the highest nursing degree you have received?
diploma associates degree baccalaureate degree masters degree doctorate degree other:

How many years have you have worked as a nurse?
I'm a student 1-5 years 6-10 years 11-20 years 21-30 years 31+ years

If you are currently employed in nursing what area are you employed in?
not currently employed hospital public health department occupational health ambulatory care physicians office hospice long term care facility home care school health other

What would you prefer to wear to work?
scrubs uniform street clothes with lab coat other

What do you typically wear to work?
scrubs uniform street clothes with lab coat

What I wear to work is provided by:
me my employer

What is important in a uniform?
Please indicate importance on a scale of 1 (unimportant) to 6 (very important).

	1	2	3	4	5	6
Practicality
Stylishness
Ease of maintenance
Comfort
Cost
Status
Indentifying your profession
Professional appearance
Other

Would you prefer a uniform to be?
colored white patterned

What should a uniform ideally signify?
Please indicate importance on a scale of 1(unimportant) to 6 (very important).

	1	2	3	4	5	6
The individual nurse
The nursing profession
The institution you work at

What does a uniform currently signify?
Please indicate importance on a scale of 1(unimportant) to 6 (very important).

	1	2	3	4	5	6
The individual nurse
The nursing profession
The institution you work at

Who are you thinking of when you select a uniform/work clothes?
Please indicate importance on a scale of 1(unimportant) to 6 (very important).

	1	2	3	4	5	6
Your self
Patient
Patient's Family
Your peers
Your employer

What type of footwear do you prefer to wear?
sneakers clogs street shoes traditional nursing shoes

What color of footwear would you prefer?
white black brown blue other

What critical design elements would be in your ideal uniform?

How many pieces would you prefer that your uniform consist of?
one piece (dress or jumpsuit) two piece (top & bottom) three piece (top, bottom, cover up)

What type of pieces would you like to choose from? Choose as many as desired.
skirt
pants
coveralls
dress
cardigan
jacket
lab coat
smock
jumper

What type of fit do you prefer?
tailored fit loose fit

What type of waist do you prefer?
elastic waist drawstring waist fitted waist with closure combo elastic with closure front

What type of closure do you prefer? Choose as many as desired.
buttons
snaps
hook and eye
zipper
Velcro

What type of top do you prefer?
pull over front opening

What type of neckline do you prefer?
collar V neck sqaure neck round neck

What type of fabric would you prefer? Choose as many as desired.
cotton
cotton/polyester blend
polyester
woven
sports fabric (stretch fabrics, synthetic jerseys)
knits/jersey
light weight fabric
medium weight fabric
heavy weight fabric

What uniform fabrics are important? Choose as many as desired.
stain release
wrinkle free
odor release
opacity
comfort in warm conditions
comfort in cold conditions

How many pockets do you need?
1-2 3-4 5-6 7-8

Is it desirable to bring back a hat or cap in any form, or for any particular function?
yes no

Please briefly explain your answer regarding the cap

Is there anything currently which you are not allowed to wear in your place of employment? If so, what?

Please provide any other comments and opinions about your current work dress or your ideal clothing for work.