Thank you for taking the time to complete our survey. Your participation is important to learn about
your health needs. The results of this survey will help Family Health Centers of Southwest
Florida and other area organizations develop services and programs to better serve the
health needs in your community.  Responses are completely anonymous.

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* 1. How would you rate the general health of residents in your area?

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* 2. How would you rate the quality of healthcare in your area?

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* 3.  Do you receive healthcare services at Family Health Centers of Southwest Florida or one of their practices, for example First Choice KidCare or Elite Healthcare?

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* 4. If no, where do you go to get healthcare (select all that apply)?

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* 5. How do you choose your healthcare providers?

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* 6. What type of insurance do you have?

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* 7. Do you receive dental care services at Family Health Centers of Southwest Florida?

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* 8. If no, where do you go to get dental care services (select all that apply)?

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* 9. What type of dental insurance do you have?

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* 10. Which of the following do you feel are the three most important health concerns in your area (select three)?

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* 11. Which of the following do you feel are the three most important risky behaviors in your area (select three)?

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* 12. What do you think is the main reason that keeps people in your area from seeking medical treatment?

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* 13. Are there services that you or people you know have difficulty accessing?

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* 14. What does your area need to improve the health of your family, friends, and neighbors?

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* 15. Please share any additional comments you have about healthcare needs in your area.

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* 16. What is your Zip Code?

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* 17. Are you a permanent, seasonal, or temporary resident of the county?

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* 18. Age:

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* 19. Gender:

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* 20. Race:

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* 21. Ethnicity:

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* 22. What is your primary language?

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