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Health Concerns of Gasconade County Survey

Gasconade County received special funding to improve one health issue in the county. We would like your input to learn more about which issues are important to you. As a thanks for your time and input, those who complete this survey are eligible to enter a drawing for one of several $200 gift cards provided by the Building Communities for Better Health Grant.
1.Do you live in Gasconade County?
2.If no, stop the survey. If yes, what ZIP code do you live in?(Required.)
3.What is your gender identity?
4.What is your age?
5.Which race or ethnicity best describes you? (Check one or more.)(Required.)
6.What is your highest level of education?
7.What is your household income before taxes?
8.In the following list, which two health issues have the greatest impact on overall health in Gasconade County? Select only two:(Required.)
9.Thinking about yourself, your family, and your friends, which two health issues in the following list cause the most visible stress or hardship? Select only two:(Required.)
10.In the following list, which two issues do you believe the community is most ready to address? Select only two:(Required.)
11.Add any comments about health concerns in Gasconade County:
12.To enter the drawing for one of several $200 gift cards, please provide your phone number.
13.As an alternate way to reach you, provide your email address.
Thank you for helping shape the health of Gasconade County!

If you would like more information, please contact us at the number below.
Gasconade County Health Department
1714 Wein Street
Hermann, MO 65041
(573) 486-3129

This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as a part of a financial assistance award totaling $4,446,758 with 100 percentage funded by the CDC/HHS and 0 percentage funded by non-government source(s). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U. S. Government.
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