Clayton County Community Health Assessment

Clayton County - How are we doing?

We want to know your opinion about our community health and quality of life. We plan to use the information to develop a community health improvement plan so that we may serve you better.

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1. Zip Code you live in:

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2. Sex

Male

Female

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3. Age:

25 or less

26-39

40-54

55-64

65 or older

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4. Marital Status

Married/living with partner

Not married/single

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5. Household income per year:

Less that $20,000

$20,000-$29,000

$30,000-$49,000

more than $50,000

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6. Ethnicity/Race

African American/Black

Asian/Pacific Islander

Hispanic/Latino

Native American

Caucasian/White

Other (please specify)

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7. Education Complete

In high school/middle school

Less than high school/not attending now

High school/GED

College degree or higher

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8. How do you pay for health care like doctor visits and prescription medications:

Pay cash (no insurance)

Health Insurance with private company (Blue Cross, Aetna, HMO, etc.)

Medicaid (Wellcare, Amerigroup, Peachstate)

Medicare (disabled or over 65)

Veteran's insurance (VA hospital)

Indian Health Services

Other (please specify)