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

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

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

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

5.What is your zip code?

6.What is your gender?

7.What is your race?

8.Are you Hispanic/Latino?

Yes

No

9.What is your highest level of education?

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

11.Do you have adequate healthcare coverage?

Yes

No