1.What county do you reside in?

Fannin

Gilmer

Lumpkin

Murray

Other

2.How would you rate our community's overall health status?

Excellent

Good

Fair

Poor

Very Poor

3.What are the most important health problems that you see in our community?
(Select the top 4)

Cancer - General

Diabetes

Heart Disease

High Blood Pressure

Poor Nutrition

Substance Abuse - Alcohol

Substance Abuse - Drugs

Asthma - Children

Immunizations - Children

Teen Pregnancy

Dental Problems

Unprotected Sex

Depression/Mental Health - Children

Depression/Mental Health - Adults

Obesity

Respiratory Diseases - Adults

4.What is the most important factor when selecting a primary healthcare provider? (Select the top 2)

Price

Provider Credentials

Access

Quality

Location

5.What do you do if you need medical care on nights or weekends?

Emergency Room

Call Healthcare Provider

Call Insurance Company

Wait until the next business day

6.What barriers do you feel exists when accessing primary healthcare?
(Select the top 2)

Transportation

Wait Times

Does Not Accept Insurance

Lack of Insurance Coverage

High Cost of Healthcare

Language Barrier

7.What barriers do you feel exists when accessing dental care?
(Select the top 2)

Transportation

Wait Times

Does Not Accept Insurance

Lack of Insurance Coverage

High Cost of Healthcare

Language Barrier

8.What barriers do you feel exists when accessing behavioral healthcare?
(Select the top 2)

Transportation

Wait Times

Does Not Accept Insurance

Lack of Insurance Coverage

High Cost of Care

Language Barrier

9.What do you think about access to:

Occupation Therapy

Speech Therapy

Physical Therapy

Substance Abuse Treatment

Good or Bad

-- Select an option --GoodBad

-- Select an option --GoodBad

-- Select an option --GoodBad

-- Select an option --GoodBad

10.Do you speak Spanish in the home?

Yes

No