Please complete this survey.
Illinois Valley Community Hospital needs your help to make sure we are meeting the healthcare needs of our community.

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* 1. What are the three greatest health needs facing you and your family in the next two year?

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* 2. To what extent are your health needs being met in the following areas?

  Not at all met 1 2 3 4 5 totally met
Availability of quality health care services
Access to family physicians
Convenient hours at area clinics
Availability of urgent care
Availability of transportation
Availability of specialists
Availability of specialized treatment
Availability of home health care

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* 3. To what extent do you feel the following issues are a concern? (Housing Issues)

  Major Concern Minor Concern No Concern
Availability of rent or utility assistance
Homelessness
Availability of affordable housing
Assistance with home repairs

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* 4. To what extent do you feel the following issues are a concern? (Social Issues)

  Major Concern Minor Concern No Concern
Hunger or need for emergency food
Crime in our communities
Language barriers
Cultural differences or discrimination
Physical or Sexual Abuse or violence among adults
Physical or Sexual Abuse or violence against children
Physical or Sexual Abuse or violence against the elderly
Suicide
Unplanned pregnancies
Parenting skills
Access to safe and affordable child care services

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* 5. To what extent do you feel the following issues are a concern? (Health Care Issues)

  Major Concern Minor Concern No Concern
Access to adequate health care services
Access to affordable women's health care services
Alcohol and/or drug abuse among youth
Alcohol and/or drug abuse among adults
Access to affordable addiction treatment services
Access to affordable dental care
Access to affordable vision care
Financial assistance for prescriptions and/or medical supplies
Affordable services for mental health
Adult day services
In-home care for the elderly or disabled

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* 6. To what extent do you feel the following issues are a concern? (Education or School Related Issues)

  Major Concern Minor Concern No Concern
Truancy/Skipping school
Dropout
Gang activity
Violence in schools
Education on mental health/substance abuse
Illiteracy or lack of education
Cyber bullying

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* 7. To what extent do you feel the following issues are a concern? (Employment and Economic Issues)

  Major Concern Minor Concern No Concern
Unemployment level in your community
Availability of affordable training for employment or trade skills
Lack of benefits/insurance plans
Ability to meet the needs of your family

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* 8. To what extent do you feel the following issues are a concern? (Transportation issues)

  Major concern Minor concern No concern
Lack of public transportation

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* 9. To what extent do you feel the following issues are a concern? (Spiritual Needs)

  Major concern Minor concern No concern
Spiritual support
Religious (Spiritual) Values

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* 10. Gender?

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* 11. Age?

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* 12. Ethnicity

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* 13. Annual Income?

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* 14. Zip code

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* 15. Number of Adults in Household?

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* 16. Number of Children in Household?

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