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CHA Survey #2- Community Health Resources

1. Community Health Resources

This section of the survey asks about your perceptions of COMMUNITY HEALTH RESOURCES in Broome County.

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* 1. Please answer the following questions

	Cost	Transportation	Language	I do not have trouble
What prevents you from getting essentials such as ... food?	What prevents you from getting essentials such as ... food? Cost	What prevents you from getting essentials such as ... food? Transportation	What prevents you from getting essentials such as ... food? Language	What prevents you from getting essentials such as ... food? I do not have trouble
Other (please specify)
What prevents you from getting essentials such as ... clothing?	What prevents you from getting essentials such as ... clothing? Cost	What prevents you from getting essentials such as ... clothing? Transportation	What prevents you from getting essentials such as ... clothing? Language	What prevents you from getting essentials such as ... clothing? I do not have trouble
Other (please specify)
What prevents you from getting essentials such as ... housing?	What prevents you from getting essentials such as ... housing? Cost	What prevents you from getting essentials such as ... housing? Transportation	What prevents you from getting essentials such as ... housing? Language	What prevents you from getting essentials such as ... housing? I do not have trouble
Other (please specify)
What prevents you from getting essentials such as... transportation?	What prevents you from getting essentials such as... transportation? Cost	What prevents you from getting essentials such as... transportation? Transportation	What prevents you from getting essentials such as... transportation? Language	What prevents you from getting essentials such as... transportation? I do not have trouble
Other (please specify)

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* 2. Please answer the following questions

	Always	Sometimes	Rarely	Never
Do you have persons with whom you can share problems?	Do you have persons with whom you can share problems? Always	Do you have persons with whom you can share problems? Sometimes	Do you have persons with whom you can share problems? Rarely	Do you have persons with whom you can share problems? Never
Do you have persons with whom you can get help when needed?	Do you have persons with whom you can get help when needed? Always	Do you have persons with whom you can get help when needed? Sometimes	Do you have persons with whom you can get help when needed? Rarely	Do you have persons with whom you can get help when needed? Never

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* 3. Where do you get information about health resources available in your community? [Check ALL that apply]

School

Church

Neighbors

Family

TV

Newspaper

Internet

Health Department

Other (please specify)

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* 4. Do you have a healthcare provider that you see regularly?

Yes

No

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* 5. How many times have you gone to the ER in the last year, and what were the reasons for the visits?

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* 6. Have you been to the Free Clinic (held at the Broome County Health Department) when you were sick or needed health care?

Yes

No

Would rather not say