2025 Forsyth County Community Health Opinion Survey

1.What is the 5-digit Zip Code where you live?
2.How old are you?(Required.)
3.Which of the following best describes your race/ethnicity? Select all that apply.(Required.)
4.How do you describe yourself?(Required.)
5.Which of the following best identifies how you think of yourself?(Required.)
6.Select the language(s) that you speak regularly. Select all that apply.(Required.)
7.Select the language (s) that you read and write regularly. Select all that apply.(Required.)
8.What is the highest level of school, college or vocational training that you’ve received? (If you are currently enrolled, select the highest grade/degree received).(Required.)
9.What range best describes the total annual household income for all the members in your household? (Total income includes wages, salary, commissions, bonuses, retirement, tips; interest, dividends, rental income, royalty income, income from estates/trusts; Social Security; Railroad Retirement; and Supplemental Security Income (SSI)).
10.How many people live in your household?(Required.)
11.Do you have health insurance?(Required.)
12.Do you have dental insurance?(Required.)
13.How much time in a typical day do you spend doing physical activity (such as running or walking, exercise classes, sports, golf, gardening, etc.)
14.In the past 12 months, did you ever cut the size of your meals or skip meals because there wasn’t enough money for food?(Required.)
15.If you said “yes” to question 14, what prevented you or someone else in your household from getting enough food? Choose the best answer.(Required.)
16.Most of us don’t eat healthy all the time. When you aren’t eating a healthy diet, what do you think makes it hard for you to eat healthy? Choose the best answer.(Required.)
17.In the past 12 months, were there times when you were worried about having enough money to pay rent or a mortgage?(Required.)
18.In the past 12 months, were there times when you did not have electricity, water, or heating in your home?(Required.)
19.How often are you able to receive health information in your preferred language?(Required.)
20.What is your comfort level when asking questions of your doctor, nurse, dentist, or pharmacist about your health?(Required.)
21.How long has it been since you last visited a dentist for a regular checkup or cleaning (Exclude times you visited a dentist because of pain or an emergency)?(Required.)
22.If you chose ‘Three to Five Years’ or more for question 21, what prevented you or anyone in your household from getting necessary oral healthcare?(Required.)
23.How long has it been since you last visited a health care provider for a regular checkup (Exclude times you visited a health care provider because you were sick, injured, pregnant or an emergency room visit)(Required.)
24.If you chose Three to Five Years or more for question 23, what prevented you or anyone in your household from getting the necessary healthcare?(Required.)
25.For households with infants (babies younger than age 1 year), during the 3 months before Mom got pregnant, how often did Mom use e-cigarettes ('vapes') or other electronic nicotine products?(Required.)
26.For households with infants (babies younger than age 1 year), in the first 3 months before Mom got pregnant, how many cigarettes did she smoke on an average day?(Required.)
27.For households with infants (babies younger than age 1 year), during the 3 months before Mom got pregnant with the new baby, was Mom told that she had any of the following health conditions?(Required.)
28.For households with infants (babies younger than age 1 year), did Mom receive prenatal care during her pregnancy?(Required.)
29.For households with infants (babies younger than age 1 year), did Mom develop any of the following health conditions during pregnancy?(Required.)
30.For households with infants (babies younger than age 1 year), did Mom have alcoholic drinks during the first trimester (first 3 months of her pregnancy)?(Required.)
31.For households with infants (babies younger than age 1 year), did Mom have alcoholic drinks during the second trimester (when she was 4-6 months pregnant)?(Required.)
32.For households with infants (babies younger than age 1 year), did Mom have alcoholic drinks during the third trimester (last 3 months of the pregnancy)?(Required.)
33.If there is a baby (family member or not) in your household, how often has he or she been placed in a sleeping position on his or her side or stomach?(Required.)