2013 PRMC Community Health Needs Assessment Survey

1. Do you have a primary care physician?

Do you have a primary care physician? Yes

2. What do you think are the biggest health concerns affecting Delmarva?

What do you think are the biggest health concerns affecting Delmarva? Overweight/Obesity

Diabetes/Sugar

Heart Disease

Mental Health

Access to Healthcare

Asthma/Lung Disease

Traffic Accidents

SIDS

High Blood Pressure/Stroke

Smoking/Drug/Alcohol Use/Abuse

Cancer

STDs

Dental Health

Injuries

Other (please specify)

3. What do you think are the reasons that prevent you or others in our area from getting the healthcare they need? Check all that apply.

What do you think are the reasons that prevent you or others in our area from getting the healthcare they need? Check all that apply. No health insurance No transportation Too expensive Local doctors are not part of insurance plan	Service that I/others need is not available here Doctor is too far from home Can't get an appointment with physician
Other (please specify)

4. Where do you get the majority of your health information?

Where do you get the majority of your health information? Doctor, nurse, pharmacy

Hospital

Health Department

Library

Church

Internet/Website

Friends/Family

Other (please specify)

5. Do you have idea or recommendations to help improve the health of the people on Delmarva or assist in access to healthcare services in our area? Please tell us.

Do you have idea or recommendations to help improve the health of the people on Delmarva or assist in access to healthcare services in our area? Please tell us.

6. Please tell us your age range.

Please tell us your age range. Under 18 years

19-24 years

25-30 years

31-40 years

41-50 years

51-60 years

61-65 years

66-70 years

71 + years

7. Please tell us your gender.

Please tell us your gender. Male

Female

8. Please tell us your ethnicity.

Please tell us your ethnicity. African American

Caucasian

Asian/Pacific Islander

Hispanic

Other (please specify)

9. Please tell us the county that you live in.

Please tell us the county that you live in. Accomack

Dorchester

Somerset

Sussex

Wicomico

Worcester

Other (please specify)