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1. What health concerns prevent you from living a healthy lifestyle?

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2. Does anything prevent you from accessing healthcare? If so, what is it?

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3. When you consider the most important health priorities in Bond County, what are they?

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4. What could be offered to you and/or the community to improve health and wellness?

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5. What is your zip code?

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6. What is your gender?

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7. What is your race?

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8. Are you Hispanic/Latino?

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9. What is your highest level of education?

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10. What is your approximate household income before taxes? If you prefer not to answer, please indicate.

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11. Do you have adequate healthcare coverage?

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