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* 1. What is your zip code?

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* 2. What is your age:

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* 3. What is your ethnicity?

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* 4. How do the following issues affect your community?

  Very Negative Effect Some Negative Effect No Effect Some Positive Effect Very Positive Effect No Opinion/Don't Know
availability of mental health care
cost of mental health care
availability of emergency mental health care services
poverty
children in poverty
illegal drug use
number of Foster Care providers
prescription drug abuse
aging county population
availability drug treatment/rehabilitation services
cost of drug treatment/rehabilitation services
availability of drug treatment/rehabilitation in-patient facilities
cost of drug treatment/rehabilitation in-patient facilities
suicide rates

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* 5. Do you see a need for the following services/facilities in your community?

  No need Slight need Definite need Extreme Need No opinion/Don't know
mental health services
emergency mental health services
illegal and/or prescription drug education
illegal and/or prescription drug treatment/rehabilitation services
illegal and/or prescription drug treatment/rehabilitation in-patient facility
Foster Care providers
Foster Care training
suicide prevention education
poverty resources
resources for seniors/elderly population

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* 6. Open comments:

T