Thank you for sharing your time with us to complete this survey.  Survey results will be used to complete our Community Health Needs Assessment and will be shared with the community by November 1, 2016.

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* 1. What county do you live in?

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* 2. What language do you speak most often?

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* 3. What is your age?

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* 4. What is your gender?

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* 5. What are the primary or most important health needs impacting YOU or YOUR FAMILY?  (May select up to 3 answers)

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* 6. What are the primary or most important health needs impacting your COMMUNITY?  (May select up to 3 answers)

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* 7. Which race/ethnicity best describes you? (Please choose only one.)

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* 8. How would you describe your current health?

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* 9. Please select the one statement that currently reflects your health insurance status.

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* 10. What services would you like to see offered at Central Iowa Healthcare?

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* 11. What is your vision of a healthy community?

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