Burlington County Community Health & Quality of Life Survey

 
Please take a few minutes to complete the survey below. The Burlington County Health Department is seeking your opinion about the quality of life in your community and ways to improve upon it. Survey results, along with other data, will be used to revise the county-wide Community Health Improvement Plan. All responses are strictly confidential and participation is voluntary. We thank you for your support in helping to improve our county. Any questions about the survey can be directed to John Sivon at 609-265-5467.
1. Please choose the things that would "most improve" the quality of life in your community.
Select All That Apply
2. From your selections above, please rank the top 3 things that would improve quality of life:
3. Please choose the major “health problems” that have the "greatest impact" on overall health in your community.
Select All That Apply
4. From your selections above, please rank the top 3 things that you would consider as major “health problems”:
5. Please choose the major “risky behaviors” that have the "greatest impact" on overall health in your community.
Select All That Apply
6. From your selections above, please rank the top 3 things that you would consider as major "risky behaviors":
Now that we have obtained your views on ways to improve the health of your community, please take a few minutes and tell us about yourself. Providing this information will help us learn how different types of people feel and experience life in their community. Your responses will be kept strictly confidential
7. What town do you live in?
8. How long have you lived in this town?
9. Gender:
10. Race/Ethnic Group:
*
11. Age:
12. Marital Status:
13. Education (what is the highest grade you completed?):
14. Household Income:
15. How many people does this income support?
16. Do you have health insurance?
17. Primary language spoken in my home:
18. How do you get information about your community?
19. Additional Comments:
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