Question Title

* 1. Where do you live?

Question Title

* 2. In the past two years, did you or a family member want or need any of these services?

Question Title

* 3. In the past two years, have you or a family member experienced difficulty in accessing any of the services listed above?

Question Title

* 4. What is your age group? 

Question Title

* 5. What is the highest level of education you have completed?

Question Title

* 6. What is your household income?

Question Title

* 7. To you and/or your family, please list the three most important factors for a healthy community in the comment box. (examples could be: access to primary care and services, cost/affordability, technology, access to specialty care, access to diagnostic services/lab/xray, health education/prevention, access to healthy foods/exercise, transportation to medical appointments)

Question Title

* 8. To you and your family, please list the top three health challenges (barriers to care) in your community in the comment box.

Question Title

* 9. For yourself, what are your personal TOP three health challenges?  Please list in comment box.

Question Title

* 10. How would you rate the overall health of your community?

Question Title

* 11. How would you rate your own personal health?

Question Title

* 12. How do you pay for your/your family's healthcare?

Question Title

* 13. Do you have a primary care provider (i.e., Doctor, Physician Assistant, Nurse Practitioner) that you see for routine health needs?

Question Title

* 14. When it comes to your primary care provider and the care and services you receive, please check all areas that are most important to you.  Your additional comments are welcome in the comment section.

Question Title

* 15. Thank you very much for your time in filling out this survey.  Please feel free to list all and any additional suggestions in the comment section.

0 of 15 answered
 

T