Big Horn County Community Health Needs Assessment Survey 2025
1.
What is your ZIP code?
2.
What is your age?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
3.
What is your gender?
Male
Female
Prefer not to answer
4.
What is your racial/ethnic identification? (Check all with which you identify)
White/Caucasian
Black/African American
Native American
Asian
Hispanic
Multi-racial
Other (please specify)
5.
Check the most accurate statement regarding health insurance.
I am on Medicare
I am on Medicaid
I have insurance through my employer
I pay for insurance through the exchange system
I do not have insurance
6.
Where do you typically go for your healthcare? (Check all that apply)
Greybull
Basin
Lovell
Powell
Cody
Billings
Worland
Other (please specify)
7.
How would you describe your overall health?
Excellent
Very Good
Fair
Poor
8.
Where do you and your family get most of your health information?
Family or friends
Newspaper/Magazine
Internet
Doctor/Health Professional
Television
Hospital
Health Department
Radio
Religious Organization
School
Other (please specify)
9.
Please select the top three health challenges you face.
Cancer
Diabetes
Overweight/Obese
Lung Disease
High blood pressure
Stroke
Heart Disease
Joint pain
Back pain
Mental health issues
Alcohol overuse
Drug addiction
I do not have any health challenges.
Other (please specify)
10.
Where do you go for routine health care? (Please select one)
Physician's office
Health department
Emergency room
Urgent care clinic
I do not receive routine healthcare
I would not seek healthcare
Other (please specify)
11.
What are the top health issues in your community? (Check all that apply)
Mental health
Substance abuse
Cancer
Heart Disease
Accidents (Unintentional injuries)
COPD
Alzheimer's Disease
Stroke
Diabetes
Suicide
I don't know
Other (please specify)
12.
Have you had a routine physical exam in the past two years?
Yes
No
I don't know
13.
Have you ever delayed care due to cost?
Yes
No
14.
Do you struggle with transportation issues?
Yes
No
15.
Which of the following preventative procedures have you had in the past 12 months? (Check all that apply)
Mammogram
Pap smear
Prostate cancer screening
Flu shot
Colon/rectal exam
Blood pressure/sugar check
Cholesterol screening
Vision screening
Hearing screening
Cardiovascular screening
Bone density test
Dental cleaning/x-rays
Physical exam
None of the above
16.
Have you used any health services in the past 12 months?
Yes
No
17.
Do you or a member of your family live with a chronic disease? (Example: arthritis, asthma, diabetes, COPD)?
Yes
No
18.
Is there a health or wellness need that you are aware of in our area?
19.
Please list any other comments or information you would like to share.
Thank you for taking the time to participate in our survey.
