In an effort to ensure that Gordon Hospital is continuing to meet the needs of our community, we are participating in a Community Health Needs survey. We are asking that you kindly take a few minutes and fill this survey out so that we can better meet your future healthcare needs. The survey is anonymous and will only take you about 10 minutes to complete. However, your answers will be vital in helping us address the health issues of Calhoun and Gordon County. Thank you for helping us improve our community's health.

* 1. How would you rate our community's overall health status?

* 2. How would you rate your own health status?

* 3. If you are a parent, do you talk openly with your child or children about sex, abstinence and contraceptives?

* 4. What would you see as the 4 greatest health problems in our community? Please rate the greatest impact on our community as 1 followed by your other 3 top choices.

* 5. Which three risk factors are the most common in our community? Please rate your most important as 1 and so on.

* 6. Do you immunize yourself and/or your child or children?

  Yes No N/A
Childhood Vaccines
Child Flu Shot
Adult/Parent Flu Shot

* 7. If no, why?

* 8. Have you had thoughts of harming yourself or do you know someone who has had thoughts of harming himself/herself?

  Yes No

* 9. If so, did you/they seek help?

* 10. Do you smoke or use tobacco products?

* 11. How often do you drink alcohol?

* 12. How often do you exercise?

* 13. If you are a parent, did you or your spouse take advantage of prenatal care during the pregnancy?

* 14. If not, why?

* 15. If you had prenatal care, did you use an OB/GYN physician that has an office located in Calhoun?

* 16. Do you and your family eat at least three meals a day?

* 17. If not, why?

* 18. Is faith part of your everyday life?

* 19. Who do you trust for your health care?

  Gordon Hospital Hamilton Medical Center Floyd Medical Center Redmond Regional Medical Center Cartersville Medical Center Piedmont Mountainside Other N/A
Heart Health
Mammography/Breast Health
Surgical Care
Physical Therapy
Home Care
Wound Care
Urgent Care
Promotion of Good Health

* 20. When choosing a hospital for your health care, how much influence does your physician have in your choice?

* 21. How far are you willing to travel for hospital care?

* 22. What is your gender?

* 23. Please choose one that best describes your race/ethnicity.

* 24. Please provide your age range.

* 25. Please choose your zip code.

* 26. I currently have health insurance.

* 27. Please choose the box that represents your income best.

* 28. What is the highest level of education you have completed?

  Yes No N/A
Graduated from high school
Some college
Graduated from college
Some graduate school
Completed graduate school

* 29. Are you currently employed?

* 30. Are you disabled?