Buffalo Trace Regional Health and Wellness Survey, Spring 2011

Please take a few minutes to complete the survey for us.

Your responses are strictly confidential and their origin cannot be traced.

1. Please type your County of Residence in the box below

2. What is your age group?

3. How would you rate the Overall Health of your County?

4. How would you rate your County as a “Safe County?”

5. How would you rate your own personal health?

6. How would you rate your own personal safety?

7. From the following list, what do you think are the 3 most needed to improve the well being in your county? (Those things which most improve the quality of life in your county) PLEASE CHOOSE ONLY 3

8. From the following list, what do you think are the 3 greatest health problems in your county? (Those problems which have the greatest impact on overall county health) PLEASE CHOOSE ONLY 3

9. From the following list, what do you think are the 3 most risky behaviors in your county? (Those behaviors which have the greatest impact on overall county health) PLEASE CHOOSE ONLY 3

10. In general, how satisfied are you with the overall quality of life in your own neighborhood?

  1 2 3 4 5 6 7 8 9 10
1= Worst and 10= Best

11. In general, how would you describe your neighborhood as a place to raise children?

  1 2 3 4 5 6 7 8 9 10
1= Worst and 10=Best

12. In general, how would you describe your neighborhood as a place to grow old?

  1 2 3 4 5 6 7 8 9 10
1= Worst and 10= Best

13. In general, how would you describe the accessibility of health services for the aging in your county?

  1 2 3 4 5 6 7 8 9 10
1= Worst and 10= Best

14. In general, how would you describe the quality of services for the aging in your county?

  1 2 3 4 5 6 7 8 9 10
1= Worst and 10= Best

15. In general, how would you describe the accessibility of healthcare in your county?

  1 2 3 4 5 6 7 8 9 10
1= Worst and 10= Best

16. In general, how would you describe the affordability of health care in your county?

  1 2 3 4 5 6 7 8 9 10
1= Worst and 10= Best
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