2018 Community Health Survey

Please take a few minutes to complete the survey below. The purpose of the survey is to get your input about community health issues in Mendocino County. This information will be used by the Healthy Mendocino and the Community Health Needs Assessment Planning Group to identify the most important problems that can be addressed through community action. The survey should only take about 10 minutes to complete. Be assured that all answers you provide will be kept in the strictest confidence. THANK YOU!

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* 1. In the list below, what do you think are the 3 most important factors that make Mendocino County a good place to live
(Please choose just 3 answers.)

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* 2. In the list below, what do you think are the three most important health problems in Mendocino County?  The most important health problems are those that have the greatest impact on overall community health in Mendocino County. (Please choose just 3 answers.)

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* 3. How would you rate Mendocino County as a healthy community to live in? (Please select just 1 answer).

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* 4. How would you rate your own personal health? (Please select 1 answer only).

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* 5. How would you rate Mendocino County as a safe place to grow up or raise children? (Please select just 1 answer).

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* 6. In the list below, what do you think are the three most serious safety problems in Mendocino County?  (Please choose just 3 answers).

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* 7. Have you or any one in your immediate family been living with any of the following chronic illnesses?  (Select all that apply).

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* 8. Where do you most often go to access health care services for yourself and your family?  (Please select the one answer that best applies).

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* 9. If you or your family members received health care services outside of Mendocino County within the past year, what type of health services did you or your immediate family members receive? (Please select all that apply).

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* 10. If you or a family member received health care outside of Mendocino County, please choose the following choices that best explains why you went to a provider outside of the county.

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* 11. How do you pay for health care? (Please select all that apply).

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* 12. During the past year did you or any one of your immediate family members use mental health or behavioral health services? (Please select all that apply).

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* 13. If you or anyone in your immediate family needed mental health or behavioral health services were you able to get them in Mendocino County?

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* 14. How often are your daily activities negatively affected by stress? (Please select only 1 answer).

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* 15. Within the past year, what type of social service benefits, if any, did you or anyone in your family need?  (Please select all that apply).

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* 16. If you or anyone in your family needed social service benefits, were you able to get these services in Mendocino County?

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* 17. What is your current employment status?

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* 18. If you are not working or are only working part-time what are the main reasons? (Please select all that apply).

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* 19. In what type of housing do you currently live? (Please choose just 1 answer).

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* 20. Regarding your housing situation, do you..... (Please choose just 1 answer)

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* 21. Are you satisfied with your housing situation? (Please select all that apply).

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* 22. In Mendocino County, the places where I go for recreation most often are: (Please select 3)

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* 23. The following questions are for demographic purposes only, to ensure we are getting responses from a wide range of people in the county. No names or addresses are asked for in this survey.

What is your gender?

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* 24. What is your marital status?

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* 25. What is your age?

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* 26. What ethnicity are you?

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* 27. What language(s) do you speak at home?

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

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* 29. What is your home zip code? (Please chose just 1 choice).

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* 30. Which of the following best describes your current occupation? (Please select just 1 answer).

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* 31. What is your approximate income? (Please chose just 1 answer).

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