Princeton Community Hospital is conducting a Community Health Needs Assessment (CHNA) Survey. By answering these questions, you will help us identify the most important health needs in your community. The information obtained from the CHNA will be used in the development of an action plan to improve the health of local community members.

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* 1. What ZIP code is your home located? (enter 5-digit ZIP code; for example, 24740)

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* 2. Have you or someone in your household used the services of Princeton Community Hospital or Behavioral Health Pavilion of the Virginias in the past 24 months? 

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* 3. If you answered "No" in question 2, at which hospital were services rendered?

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* 4. If you did not receive care at PCH, Please choose the reason or reasons why you did not go to PCH for your care:

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* 5. What keeps you from getting medical care that you need?

  Not a problem A small problem A major problem
Cost of assistance
Not eligible/do not qualify for assistance
Lack of transportation
Lack of childcare
Do not know where to go for assistance
Do not want to ask for assistance
Assistance is not available in my area
Prior bad experience with obtaining assistance
Have to work during business hours of assistance provider
Health or disability prevents me from seeking assistance

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* 6. Do you have any of the following residents living in your household?

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* 7. Did you receive dental care in the past 12 months?

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