Brownwood | Brown County Health Department

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* 1. Have you ever used any of the Brownwood | Brown County Health Department Services or Programs?

Yes

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* 2. Do you have a Medical Home?

Yes

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* 3. Do you have Medical Insurance?

Yes

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* 4. If you do not have Medical Insurance, would you like to receive assistance? If yes, please provide contact information below.

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* 5. Did you get a COVID vaccine?

Yes

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* 6. Did you get a 2nd dose and booster?

Yes

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* 7. If you have children under the age of 18 years old, are they vaccinated?

Yes

N/A

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* 8. If you did not get vaccinated, what are the reasons or barriers for not getting vaccinated?

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* 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)

Brownwood | Brown County Health Department

Question Title

* 1. Have you ever used any of the Brownwood | Brown County Health Department Services or Programs?

Question Title

* 2. Do you have a Medical Home?

Question Title

* 3. Do you have Medical Insurance?

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?

Question Title

* 6. Did you get a 2nd dose and booster?

Question Title

* 7. If you have children under the age of 18 years old, are they vaccinated?

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.)

Question Title

* 10. What Medical Services are needed in Brown County?