Please take a few minutes to complete our survey.  The purpose is to get your opinion about community health strengths and concerns in Vermilion County.  Your input is important and all individual information will be kept confidential.  

Question Title

* 1. What are the 5 greatest STRENGTHS of Vermilion County? Please check exactly 5.

Question Title

* 2. What do you think are the 5 most important CONCERNS in Vermilion County? Please check exactly 5.

Question Title

* 3. How would you rate your personal health? (Circle One) Unhealthy Somewhat Healthy Healthy

Question Title

* 4. Have you had a routine physical exam in the past two years? 

Question Title

* 5. If no, why not? (check all that apply)

Question Title

* 6. Have you visited the dentist in the past two years?

Question Title

* 7. If no, why not? (check all that apply)

Question Title

* 8. Have you gotten professional help for any personal or emotional problem?

Question Title

* 9. If yes, who did you seek help from?

Question Title

* 10. Have any of the following kept you or the members of your household from receiving needed mental health, substance use or developmental disability related services?

Question Title

* 11. Please indicate which of the following types of gambling you have done in the last year.  Please choose one answer for each line.

  Not At All Less than once a week More than once a week
Played cards for money
Bet on Sports
Played dice games
Played the lottery (including scratchers)
Went to a casino
Played bingo
Played slot, poker or other machines
Some other form of gambling

Question Title

* 12. Please answer the following health statements that apply to you.

  Sometimes Always Never
I am physically active for 30 minutes at least 3 times per week.
I drink more than 1 sugary beverage per day. (Soda, sweet tea, etc.)
I smoke or chew tobacco products.
I use E-cigarettes / Vape.
I use illegal drugs.
I abuse or overuse prescription drugs.
I use recreational marijuana.
I use medicinal marijuana.
I consume more than 4 alcoholic drinks (if female) or 5 (if male) per day.
I feel safe in my neighborhood.
I feel safe in my community. 

Question Title

* 13. Please indicate your views on the following statements.  

  Agree Disagree Don't know
Treatment can help people with mental illness lead normal lives. 
Mental illness is a sign of personal weakness.
Mental illness can be caused by biological imbalances.
Children's mental health is essential to health, academic success, and well-being
Mental illness can be caused by environmental factors.  
Substance Use Disorder is a disease that should be treated like other medical conditions. 
People with developmental disabilities can lead self-directed, successful lives. 
People with developmental disabilities can function as members of their communities.  
Alcoholism is a disease which should be treated like other medical conditions.  

Question Title

* 14. Do you think that the following services are available and accessible in Vermilion County, even if they do not apply to you?

  Yes No
Mental Health Services
Substance / Alcohol Abuse Treatment
Medical Services
Dental Services
Support Groups
Easy access to Contraceptives (Birth Control)
Easy access to STD Services
Access to Transportation
Access to Affordable Housing
Access to Affordable Childcare
Access to Food Pantries
Access to Farmer's Markets
Food Assistance Services
Senior Care
Access to Emergency Shelter

Question Title

* 15. In the last 12 months, did you ever worry your food would run out before you got money to buy more?

Question Title

* 16. In the last 12 months, were you ever hungry but didn't eat because there wasn't enough money for food?

Question Title

* 17. Where do you get most (75%) of your food from?

Question Title

* 18. What have we not asked you about that you feel is important?

Question Title

* 19. What is your Home Zip Code?

Question Title

* 20. Are you Male or Female?

Question Title

* 21. What is your age?

Question Title

* 22. Which of the following best describes your current relationship status?

Question Title

* 23. Do you have children under the age of 18 living in your home?

Question Title

* 24. What is your employment status?

Question Title

* 25. Annual Household Income

Question Title

* 26. Your Highest Level of Education

Question Title

* 27. Are you of Hispanic or Latino Origin?

Question Title

* 28. What is your Race?

Question Title

* 29. Where do you usually go when you are sick or need healthcare?

Question Title

* 30. How do you pay for your healthcare?

Question Title

* 31. What is the best way to get information to you about health /community resources?  Please check all that apply

0 of 31 answered
 

T