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Community Needs Assessment

Thank you for taking part in this important survey!

Hilltown Community Health Center (HCHC) is conducting a Community Needs Assessment Survey to better understand the needs of our community and our patients.  Our mission is to create access to high quality accessible health care and promote well-being for individuals, families, and our communities.  We’d like to find out how you feel about the most important health needs in your community so that we can do so effectively.  

This survey should only take 5-7 minutes to complete. 

We want to assure you that your responses are completely anonymous. Responses to anonymous surveys cannot be traced back to the respondent. No personally identifiable information is captured unless you voluntarily offer personal or contact information in any of the comment fields. Additionally, your responses are combined with those of many others and summarized in a report to further protect your anonymity.

Eliza Lake, CEO

1.What are the biggest health issues or concerns in your community? (Check all that apply)
2.What keeps people in your community from seeking treatment for medical or dental needs? (Check all that apply)
3.Please select the top three health challenges you face.
4.Which of the following are needed to improve the health of your family and neighbors? (Check all that apply)
5.What health screenings or education/ information services are needed in your community? (Check all that apply)
6.If you or someone in your family were ill and required medical care, where would you go? (check one)
7.Where do you and your family get most of your health information? (Check all that apply)
8.Please choose all statements below that apply to you.
9.Which of the following preventive procedures have you had in the past 12 months?
10.Have you had a routine physical exam in the past two years?
11.In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 11363 or 94305)
12.Are you enrolled in health insurance?
13.If not, when did you last have health insurance?
14.If not, why do you not have insurance? Check all that apply.
15.What is your current gender identity?
16.What category below includes your age?
17.How would you describe yourself by race? You may select more than one option.
18.What is your ethnic identification?
19.What is your annual household income?
Thank you for your participation!
Current Progress,
0 of 19 answered