West Elgin CHC Community Survey

We are interested in your feedback!
Complete our Community Survey if you are interested in providing feedback about what types of needs exist in western Elgin and what services would meet these needs. Please choose only 1 answer except where more than 1 answer is asked for.
Thank you for your feedback and comments.

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1. Do you have a family doctor?

Do you have a family doctor? Yes

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2. During the past year, did you always receive the health care you needed?

During the past year, did you always receive the health care you needed? Yes

3. If not, what most stopped you from getting the health care you needed?

If not, what most stopped you from getting the health care you needed? Indicated "no" to question #2

No family doctor

The service was not available

Cannot get service in a timely manner

Transportation/ location

Cost

Don't know where to go

Other (please specify)

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4. In general, would you say your health is?

	Excellent	Very Good	Good	Fair	Poor
Level of health	*In general, would you say your health is? Level of health Excellent	Level of health Very Good	Level of health Good	Level of health Fair	Level of health Poor

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5. What one health issue is most concerning to you?

What one health issue is most concerning to you? I have no concerns

Maintaining my good health

Proper nutrition

Having enough food

Proper exercise

Managing stress/ anxiety

Managing illness

Managing disability

Addiction (e.g. alcohol, drugs, smoking?

Other (please specify)

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6. Is there One thing you are planning to do, or would like to do, to improve your health?

Is there One thing you are planning to do, or would like to do, to improve your health? I do not plan on making a change

Start/ increase exercise

Lose/ gain weight

Improve eating habits

Quit/ reduce smoking

Quit/ reduce alcohol or drug use

Learn to manage stress

Educate myself on a health issue

Other (please specify)

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7. If you are planning on making a change to improve your health, what would stop you?

If you are planning on making a change to improve your health, what would stop you? I do not plan on making a change

There is nothing stopping me

Lack of opportunity

Transportation

Disability/ health concern

Cost

Lack of time

Lack of information

lack of support

Embarassment

Other (please specify)

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8. Where do you get health information?

Where do you get health information? I do not look for this information

It does not matter where I get information

Health care provider

Friends/ family

Print media (e.g. TV, Internet)

Other (please specify)

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9. If stress is an issue in your life, which most affects your level of stress?

If stress is an issue in your life, which most affects your level of stress? Stress is not an issue in my life

Money

Work/ job

Family/ relationships

Health

Time/ commitments

Other (please specify)

West Elgin CHC Community SurveyExit this survey >>

*1. Do you have a family doctor?

*2. During the past year, did you always receive the health care you needed?

3. If not, what most stopped you from getting the health care you needed?

*4. In general, would you say your health is?

*5. What one health issue is most concerning to you?

*6. Is there One thing you are planning to do, or would like to do, to improve your health?

*7. If you are planning on making a change to improve your health, what would stop you?

*8. Where do you get health information?

*9. If stress is an issue in your life, which most affects your level of stress?

West Elgin CHC Community Survey
Exit this survey >>

*
1. Do you have a family doctor?

*
2. During the past year, did you always receive the health care you needed?

*
4. In general, would you say your health is?

*
5. What one health issue is most concerning to you?

*
6. Is there One thing you are planning to do, or would like to do, to improve your health?

*
7. If you are planning on making a change to improve your health, what would stop you?

*
8. Where do you get health information?

*
9. If stress is an issue in your life, which most affects your level of stress?