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* 1. What is your zip code?

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* 2. What is your gender?

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* 3. Which ethnicity best describes you? (Please choose only one.)

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* 5. How long have you lived in the area?

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* 6. How would you describe your housing situation?

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* 7. Counting all income sources from everyone in your household, what was the combined household income last year? (Optional)

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* 8. What is your highest level of education?

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* 10. What is the biggest challenge you face as an Individual?

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* 11. What is the biggest challenge you face as a Family?

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* 12. What issues most concern you regarding young persons (under 18) in your household?

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* 13. Has everyone in your family (those living in your household) seen a healthcare professional at least once in the last 12 months?   

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* 14. If the last visit for a household member was more than 12 months ago, please check why.  Check all that apply.

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* 15. If you or a household member used a hospital emergency room in the past 12 months, was it due to:

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* 16. How many times in the last 12 months have you or any household member used an Urgent Care, Rural Health Clinic or Federally Qualified Health Clinic - Check all that apply

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* 17. Do you access your health records through an online patient portal?

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* 18. What do you think are the most pressing health problems in your community?

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* 19. What medical services are most needed in your community?  ( Check all that apply)

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* 20. What types of health education services are most needed in your community? (Check all that apply)

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* 21. What health or community services should be provided that are currently not available?

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* 22. What ideas or suggestions do you have for improving the overall health of the area community?

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* 23. How effective were Macon County resources in their response to the Covid-19 pandemic?

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* 24. How could Macon County resources have improved their response to the Covid-19 pandemic?

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* 25. To be included in a drawing for one of five $100 gift cards, please complete the following information:

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