Newtown Health District - Online Tick Survey
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1.
Are you a resident of Newtown, CT ?
(Required.)
a. Yes
b. No
2.
How long have you been a resident of Newtown, CT ?
a. Less than one year
b. One to five years
c. More than 5 years up to ten years
d. more than ten years
3.
What is your age range ?
a. Under 25
b. 25 to 40
c. 41 to 60
d. 61 to 80
e. Over 80
4.
Are there children under the age of 18 living in your home ?
a. Yes, under 12 years of age only
b. Yes, 12-18 years of age only
c. Children in both age ranges
d. No
5.
As far as you know, have you ever been bitten by a deer tick ?
a. Yes
b. No
6.
Have you ever gone to the doctor and received medication for a deer tick bite ?
a. Yes
b. No
c. Unsure
7.
How many times have you gone to the doctor and received medication for a deer tick bite ?
a. Once
b. More than once
c. Never
8.
Do you use tick repellents ( spray on clothes and/or skin)?
a. Yes, all the time
b. Yes, some of the time
c. Never
9.
When you have been outside, do you wear protective clothing such as long pants, long sleeved shirts and socks and shoes to protect yourself from tick bites ?
a. Yes, all the time
b. Yes, some of the time
c. Never
10.
When you have been outside, do you shower within 2 hours/ shortly after coming indoors to protect yourself from tick bites ?
a. Yes all the time
b. Yes, some of the time
c. Never
11.
Do you do a daily tick check of your body to make sure there are no ticks on you ?
a. Yes, all the time
b. Yes, some of the time
c. Never
12.
Have you ever gone to the Newtown Health District website for information about tick-borne disease prevention ?
a. Yes
b. No ( If no skip to question 14)
c. I don't know
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