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If you are a resident of Broome County, we would appreciate your input and value your opinion. We are working on identifying ways to make Broome County healthier. Please take this 15 minute survey to help us learn more about you and what issues are important to you and your community. This survey is anonymous.  At the end of the survey there is an option to enter to win a gift card. Thank you for your time and feedback. 

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* 1. Do you live in Broome County?

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* 2. Please select your gender identity

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* 3. Please select your age group

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* 4. Which racial/ethnic group(s) do you identify with? Check all that apply

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* 5. Please select your highest level of education

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* 6. Please select an option for employment in the past 12 months

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* 7. Please select all types of health insurances that may apply to you

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* 8. Please select your estimated Household Income

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* 9. Do you have a primary healthcare provider?

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* 10. Please select the five (5) biggest health problems you believe our community is currently facing

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* 11. Which changes would you like to see in Broome County to make it a healthier place to live? Please select your top three (3)

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* 12. What keeps you from making healthier choices for both your physical and mental health such as quitting smoking, exercising more, eating healthier, etc.?

 
33% of survey complete.

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