Community Health Needs Assessment Consumer Survey

As a Sheltering Arms patient or member, your feedback is very important to us. The questions below are part of our triennial Community Health Needs Assessment. Please take a moment to let us know your thoughts. Your feedback will go a long way in helping us continue to improve quality of life in the community we serve. Thank you.

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* 1. What is your relationship with Sheltering Arms?

Patient (current or former)

Club Rec Member

Fitness/Wellness Member

Community Member

Other (please specify)

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* 2. Where do you live?

North of James River

South of James River

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* 3. Have you experienced issues with access to the following services? (check all that apply):

Medical care

Medication

Internet & Technology

Medical devices

Dental care

Transportation

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* 4. Has lack of access to any of the following contributed to you experiencing these issues? (check all that apply):

Internet & computer technology

Transportation

Financial resources

Knowledge of available services & resources

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* 5. Are there services that you do not have at present but feel that you need (check all that apply):

Medication education

Chronic disease management (e.g., diabetes, COPD, high blood pressure, etc.)

Weight management

Nutritional education and counseling

Health and wellness

Fitness training

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* 6. Which of the following do you believe are important for your health:

Peer support

Recreational/physical activities

Participation in my community

Support groups

Individual counseling

Support for caregivers

Community Health Needs Assessment Consumer Survey

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* 1. What is your relationship with Sheltering Arms?

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* 2. Where do you live?

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* 3. Have you experienced issues with access to the following services? (check all that apply):

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* 4. Has lack of access to any of the following contributed to you experiencing these issues? (check all that apply):

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* 5. Are there services that you do not have at present but feel that you need (check all that apply):

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* 6. Which of the following do you believe are important for your health:

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* 7. Do you need assistance in getting your healthcare needs met (e.g., finding services, filling out forms, etc.)?

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* 8. What is the most important thing for you to feel healthy?

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* 9. What is your biggest challenge to stay healthy?