Health Nurse Utilization Survey

Your local Community Health Office would like to know what services you think should be offered and if you use our services so we can better respond to the needs of the community.

All responses will be kept confidential and anonymous. Thank you for your time.

1. Community Zip Code

Community Zip Code

2. Gender:

Gender: Male

Female

Transgender

3. Do you have a regular health care provider such as a doctor or clinic?

Do you have a regular health care provider such as a doctor or clinic? Yes

4. Have you ever heard of your local Community Health Nurses Office?

Have you ever heard of your local Community Health Nurses Office? Yes

5. Have you ever been to your local Community Health Nurses Office?

Have you ever been to your local Community Health Nurses Office? Yes

6. If you DO NOT go to your local Community Health Nurse, why not? (Choose all that apply)

If you DO NOT go to your local Community Health Nurse, why not? (Choose all that apply) I do not know what services they offer

I feel like there is too much paperwork

I do not need any of the services they offer

I do not go to any medical offices

I do not feel that they are welcoming

I don't think I would qualify for their services

I have a regular doctor that provides all services

I feel like it costs too much

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