2026 NEW Health Community Health Survey The purpose of this survey is to get your opinion about the needs of our community. This information will be used to plan for future health center services. You will be asked about your health, your needs, demographics, and your concerns. Your participation is completely voluntary, and your responses are confidential. Please fill out the attached card to enter the raffle for a $100 Stop & Shop Gift Card. Question Title * 1. What is your 5-digit zip code? (5-digit number) . Question Title * 2. Are you a NEW Health patient? Yes No Question Title * 3. If you wrote ‘No’ above, where do you get your primary care? (If you don’t have primary care, write N/A) . Question Title * 4. Do you live in public or subsidized housing? Yes No Prefer not to answer Question Title * 5. Are you Hispanic or Latino? Yes No Prefer not to answer Question Title * 6. What is your race? (Please select only one choice that best applies to you) African American or Black American Indian or Alaska Native Asian Middle Eastern or Northern African White or European Multiple Other Prefer Not to Answer Question Title * 7. What is your age? Under 18 18-29 30-44 45-59 60+ Question Title * 8. What is the size of your household? (People living with you including yourself) 1 2 3 4 5 6+ Question Title * 9. What sex were you assigned at birth? Female Male Question Title * 10. If you don’t identify with your sex assigned at birth, please write in your gender identity. (ex. Transgender, non-binary, man, woman). Question Title * 11. What is your preferred language? English Spanish Chinese Other (Specify) Question Title * 12. What is your highest level of education? (Please Write) . Question Title * 13. Which of the following Health Problems have the biggest impact on you or community? (Please select only up to 5 choices) Cancer Heart Disease / High Blood Pressure Alcohol Use Mental Health (ex. Depression, Anxiety) Lung Disease / Asthma Smoking/Vaping Marijuana Use Eye Health / Vision Problems Opioid/Substance use Sexually Transmitted Diseases (ex-Chlamydia, HIV) Diabetes Obesity / Overweight Teenage Pregnancy Unsafe Sex / Not Using Birth Control Infectious Diseases (ex. TB/Tuberculosis, pneumonia, COVID) Other (Please write) Question Title * 14. Which of the following are the most important issues (needs) to address that impact you or your community? (Please select up to 5 issues) Lack of affordable housing Lack of job opportunities Domestic Violence Racism & Discrimination Poor water and/or air quality Lack of green or outdoor spaces Unsafe streets or neighborhoods Lack of elder care services Lack of community gathering places Problem Gambling Food insecurity (lack of access to healthy, affordable food) Other (please write) Question Title * 15. What issues prevent you, your family, or your neighbors from accessing healthcare Can’t afford prescriptions Can’t afford co-pays/ deductibles Lack of reliable transportation Work schedules or Conflicting hour Lack of access to specialty care Healthcare is confusing/difficult Can’t get an appointment within a reasonable timeframe Can’t find a primary doctor accepting new patients Fear or mistrust of healthcare providers or systems No access to internet/phone to schedule or look up care Cultural/philosophical/religious beliefs Language barriers/Lack of interpreter Don’t feel the need for routine care Racism or discrimination in healthcare Other (please specify) Question Title * 16. What are your preferred times for medical appointments? (Select all that apply) Weekdays (M-F) Morning (8am-12pm) Afternoon (12pm-4:30) Evening (4:30-8pm) Question Title * 17. Weekends (Sat/Sun) Morning (8am-12pm Afternoon (12pm-4:30pm) Evening (4:30-8:30pm) Question Title * 18. What are the biggest strengths of the physical environment where you live? Public transit Walkability Clean streets Close to parks/harbor NEW Health Center Close to the library Close to schools Social clubs Places of Worship Other (please write) Question Title * 19. How easy is it to access affordable fresh, healthy foods in your immediate neighborhood? Easy Mostly Easy Neutral A bit Hard Difficult Easy Mostly Easy Neutral A bit Hard Difficult Question Title * 20. Do you feel you have a voice in the shaping of the future of your neighborhood? Yes No I don’t know Question Title * 21. I am well informed about local health, wellness, and social events in my area. Yes No Other (Specify) Question Title * 22. In your own words, what is the greatest strength of your community? (please write): Optional Raffle Entry Question Title * 23. If you would like to be entered into a raffle for a chance to win a $100 Stop & Shop gift card, please provide the information below. Your contact information will be kept separate from your survey responses and will not be used to identify your answers. Name: Phone Number: Done