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This survey ensures that we are doing all we can to listen and understand how our communities' health resources can be improved. By completing this survey, you will provide vital information that helps us identify our communities' most significant needs. From there, we can carefully develop strategies, refine or add services, and promote programs that are all focused on the needs discovered through this survey. 
 
  • The survey is anonymous; no data will be connected to you. There are no risks to you for participating and no penalty for not participating. 
  • The survey data will be publicly available to help people and organizations improve community services. 
  • You will be asked questions about health/wellness status, needs, concerns, and challenges.
  • The survey should take between 5 and 10 minutes.
  • The deadline to submit this survey is Friday, October 21, at 5 p.m. 
We thank you for being a proactive part of our goal to meet our communities' health needs.

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* 1. What county do you live in?

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* 2. In what ZIP code is your home located? (enter 5 digit ZIP code; for example, 53581 or 53556).

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* 3. What is your age?

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* 4. What is your current gender identity?

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* 5. Including yourself, how many people live in your household?

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* 6. Thinking of the following aspects of health, how would you rate each?

  Poor Fair Good Excellent
Your overall health
Your overall mental health
Your overall dental health
Your access to health care
Your access to mental health care
Your access to dental care
Your access to healthy food choices

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* 7. Please select the top five health challenges you face.

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* 8. What types of health screenings or services are needed to keep you and your family healthy? (Check up to 5)

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* 9. Where do you get most of your health and wellness information?

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* 10. Please choose all the statements that apply to you.

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* 11. How concerned are you about the following issues in your community?

  No Concern A Little Concerned Concerned Very Concerned
Access to sidewalks/safe exercise
Alcohol use
Childcare options
Cost of health care
COVID-19
Domestic abuse or violence
Entertainment other than electronic
Gun safety
Healthy food access
Homelessness
Housing (availability and affordability)
Hunger / food security 
Illegal drug use
Mental health services
Obesity
Other infectious diseases
Prescription drug misuse
Quality of education (higher education, tech school, etc.)
Sexual abuse or violence
STDs
Suicide
Tobacco use
Vaping

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* 12. Please rate progress (since 2019) regarding community health needs.

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