Hiawatha Community Hospital Community Health Needs Survey
. Please check all that apply to you.
Please check all that apply to you.
Regularly eat 5 servings of fruits and vegetables a day
Get 30 or more minutes of exercise 5 times a week
Eat fast food more than one time a week
Deal with high levels of stress
Sleep 7 hours or more most nights
Smoke on a daily basis
Drink one or more sodas a day
Eat a balanced breakfast every morning
Have high blood pressure
Have high cholesterol
Polycystic ovarian syndrome
Sleep apnea or have loud snoring
Arthritis of knees or back
Swelling in lower extremities
Wear my seat belt in the car
Regularly consume 2 or more alcoholic drinks a day
. If you haven't seen a local physician in the last year, please check all of the reasons why.
If you haven't seen a local physician in the last year, please check all of the reasons why.
Ability to get to clinic during hours
Haven't felt the need
Specialist not available locally
Inability to get an appointment scheduled
. In my opinion the following are health issues in our community. Please check all that apply.
In my opinion the following are health issues in our community. Please check all that apply.
High blood pressure
Chronic lung disease
Additional health issues in the community:
. What activities do you consider beneficial to our community? Please check all that apply.
What activities do you consider beneficial to our community? Please check all that apply.
Additional free/low cost exercise opportunities
Healthy, safe places for children
Health education courses/programs
Safety education courses/programs
Other (please specify)
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