English Español English Brownwood | Brown County Health Department Question Title * 1. Have you ever used any of the Brownwood | Brown County Health Department Services or Programs? Yes No Question Title * 2. Do you have a Medical Home? Yes No Question Title * 3. Do you have Medical Insurance? Yes No Question Title * 4. If you do not have Medical Insurance, would you like to receive assistance? If yes, please provide contact information below. Question Title * 5. Did you get a COVID vaccine? Yes No Question Title * 6. Did you get a 2nd dose and booster? Yes No Question Title * 7. If you have children under the age of 18 years old, are they vaccinated? Yes No N/A Question Title * 8. If you did not get vaccinated, what are the reasons or barriers for not getting vaccinated? Question Title * 9. What is your racial or ethnic identity? (Select all that apply.) African-American/Black East Asian Hispanic/Latino Middle Eastern American Indian/Alaskan Native Pacific Islander South Asian Southeast Asian White Other (please specify) Question Title * 10. What Medical Services are needed in Brown County? Done