We Need Your Input

Thanks for helping us plan health outreach programs! Your answers to the questions below will be used to shape our community outreach efforts.

1. Which of these health topics are of greatest interest to you? (Select up to 5 topics)

Which of these health topics are of greatest interest to you? (Select up to 5 topics) Alzheimer’s disease

Back pain

Cancer prevention and treatment

Caring for an elder at home

Diabetes awareness

Digestive/stomach disorders

Exercise

Eye surgery

Heart health

High blood pressure

Household first aid readiness

How to find the right doctor

How to talk to your doctor

Kidney disease

Knee pain

Lung and breathing problems

Mental health

Rehabilitation care

Stroke prevention and treatment

Weight loss surgery

Why use a hospital ER

Other (please specify)

2. What kind of venue or event would be most attractive to you? (Rank each of these on a scale of 1-5, with 1 being the most appealing and 5 being the least appealing)

	1	2	3	4	5
An event held at the Hospital	*What kind of venue or event would be most attractive to you? (Rank each of these on a scale of 1-5, with 1 being the most appealing and 5 being the least appealing) An event held at the Hospital 1	An event held at the Hospital 2	An event held at the Hospital 3	An event held at the Hospital 4	An event held at the Hospital 5
An event held in your community at a public location, such as library or school	An event held in your community at a public location, such as library or school 1	An event held in your community at a public location, such as library or school 2	An event held in your community at a public location, such as library or school 3	An event held in your community at a public location, such as library or school 4	An event held in your community at a public location, such as library or school 5
A screening for a particular disease or medical condition	A screening for a particular disease or medical condition 1	A screening for a particular disease or medical condition 2	A screening for a particular disease or medical condition 3	A screening for a particular disease or medical condition 4	A screening for a particular disease or medical condition 5
An informative talk on the topic with material you can take with you	An informative talk on the topic with material you can take with you 1	An informative talk on the topic with material you can take with you 2	An informative talk on the topic with material you can take with you 3	An informative talk on the topic with material you can take with you 4	An informative talk on the topic with material you can take with you 5
A demonstration of first aid techniques, such as CPR, Heimlich maneuver, etc.	A demonstration of first aid techniques, such as CPR, Heimlich maneuver, etc. 1	A demonstration of first aid techniques, such as CPR, Heimlich maneuver, etc. 2	A demonstration of first aid techniques, such as CPR, Heimlich maneuver, etc. 3	A demonstration of first aid techniques, such as CPR, Heimlich maneuver, etc. 4	A demonstration of first aid techniques, such as CPR, Heimlich maneuver, etc. 5

3. What days/times for events such as these would be most convenient? (Rank each of these on a scale of 1-5, with 1 being the most convenient and 5 being the least convenient)

	more convenient				less convenient
Weekday mornings	*What days/times for events such as these would be most convenient? (Rank each of these on a scale of 1-5, with 1 being the most convenient and 5 being the least convenient) Weekday mornings more convenient	Weekday mornings	Weekday mornings	Weekday mornings	Weekday mornings less convenient
Weekday lunch times	Weekday lunch times more convenient	Weekday lunch times	Weekday lunch times	Weekday lunch times	Weekday lunch times less convenient
Weekday afternoons	Weekday afternoons more convenient	Weekday afternoons	Weekday afternoons	Weekday afternoons	Weekday afternoons less convenient
Weekday evenings	Weekday evenings more convenient	Weekday evenings	Weekday evenings	Weekday evenings	Weekday evenings less convenient
Saturday morning	Saturday morning more convenient	Saturday morning	Saturday morning	Saturday morning	Saturday morning less convenient

Other (please specify)

4. There are many ways to provide you with information about health and wellness events. (Rank each of these on a scale of 1-5, with 1 being the most appealing and 5 being the least appealing.)

	most appealing				least appealing
A calendar of events on the web site	*There are many ways to provide you with information about health and wellness events. (Rank each of these on a scale of 1-5, with 1 being the most appealing and 5 being the least appealing.) A calendar of events on the web site most appealing	A calendar of events on the web site	A calendar of events on the web site	A calendar of events on the web site	A calendar of events on the web site least appealing
An ad in a local newspaper	An ad in a local newspaper most appealing	An ad in a local newspaper	An ad in a local newspaper	An ad in a local newspaper	An ad in a local newspaper least appealing
A radio announcement	A radio announcement most appealing	A radio announcement	A radio announcement	A radio announcement	A radio announcement least appealing
A calendar of events that is mailed to my home	A calendar of events that is mailed to my home most appealing	A calendar of events that is mailed to my home	A calendar of events that is mailed to my home	A calendar of events that is mailed to my home	A calendar of events that is mailed to my home least appealing
A FaceBook or Twitter message	A FaceBook or Twitter message most appealing	A FaceBook or Twitter message	A FaceBook or Twitter message	A FaceBook or Twitter message	A FaceBook or Twitter message least appealing

Other (please specify)

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