Oneida County Community Survey

Approximately every five years, the Oneida County Health Department conducts an extensive review of county wide health data. Accurate local data is essential when determining the top health needs of county residents. We need your help, as the information contained in this survey is not available from other sources.

We hope you will take time to complete and return this survey. The health data gathered from this health survey will be used to assess county residents' needs in the future. Your input is very valuable and can make a difference!

Please do not take this survey more than once. You must be 18 years or older to participate in the survey.

1. What county do you live in?

What county do you live in? Oneida

Forest

Vilas

Langlade

Price

2. Do you have any of the following ongoing health conditions?

Do you have any of the following ongoing health conditions? Diabetes Heart Trouble High Blood Pressure High Cholesterol/triglycerides Asthma Lung Disease Colon Cancer Breast Cancer Prostate Cancer Other Cancers Liver Disease	Arthritis Parkinson's Disease Alzheimer's Disease Stroke Anorexia/bulimia Depression (Diagnosed) Kidney or bladder conditions Lyme disease Alcohol or drug dependency concerns Other mental health concerns None of the above
Other (please specify)

3. Have you ever had any of the following assessments or screenings?

	Yes	No
Hearing	Have you ever had any of the following assessments or screenings? Hearing Yes	No
Vision, in general	Vision, in general Yes	No
Glaucoma	Glaucoma Yes	No
Blood Pressure	Blood Pressure Yes	No
HIV/AIDS	HIV/AIDS Yes	No
Sexually Transmitted Disease	Sexually Transmitted Disease Yes	No
Depression	Depression Yes	No
Diabetes	Diabetes Yes	No
Osteoporosis	Osteoporosis Yes	No
Nutrition	Nutrition Yes	No
Skin Cancer	Skin Cancer Yes	No
Cholesterol	Cholesterol Yes	No
Colorectal Cancer	Colorectal Cancer Yes	No
Breast Cancer	Breast Cancer Yes	No
Cervical Cancer	Cervical Cancer Yes	No
PSA/Prostrate Screening	PSA/Prostrate Screening Yes	No

4. Do you have a primary care provider (family practice or general internist) who helps guide your healthcare?

Do you have a primary care provider (family practice or general internist) who helps guide your healthcare? Yes

Don't know/Not sure

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