Cottage Hospital is currently conducting its Community Health Needs Assessment to help identify ways to better serve the community. We would like your insights and opinions!

Your responses will be kept anonymous. 

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* 1. How old are you?

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* 2. What zip code do you live in?

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* 3. What is your gender?

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* 4. What's the highest level of education you have completed?

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* 5. Where do you seek regular care?

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* 6. What is your average annual household income?

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* 7. To what degree do the following community health-related issues need more focus or attention for improvement?

  No more focus needed Somewhat more focus needed Much more focus needed Don't Know
Primary care services (such as those provided by a family doctor for routine care)
Emergency care and trauma services
Long-term care or dementia care for seniors
Counseling services for mental health issues such as depression, anxiety and other for adults
Counseling services for mental health issues such as depression, anxiety and other for children
Drug and other substance abuse treatment services
Drug and other substance abuse education and prevention

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* 8. To what degree do the following community health-related issues need more focus or attention for improvement?

  No more focus needed Somewhat more focus needed Much more focus needed Don't Know
Specialty care for chronic conditions, like diabetes and heart disease
Dentistry
Care coordination or support services to help people better manage their own health care
Access to care: Transportation to medical appointments and other health services
Access to care: Financial assistance for healthcare services or prescription drugs
Other (please specify in comment box below)

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* 9. Primary care providers can have a variety of licensures, such as medical doctor (MD), osteopathic doctor (DO), nurse practitioner (NP), or physician assistant (PA). To what degree does licensure matter to you?

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* 10. What licensure does your Primary Care Providers have?

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* 11. To what degree do you agree with each of the following statements?

  Strongly disagree Disagree somewhat Agree somewhat Strongly agree Not sure
My provider cares about my health just as much or more than I do.
I trust my provider to help make the best decisions about my health care.
It is important to me to always see the same provider.
I am concerned that my provider might leave the community in the next year (i.e., retirement, new job).

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* 12. Please rate the following about scheduling appointments with your primary care provider:

  Poor Fair Good Very Good Excellent Does Not Apply
Ease of making an appointment
Appointment available in a reasonable amount of time
Available hours of appointments
0 of 12 answered
 

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