2021 Cascade County Healthy Communities Survey

Your survey responses will be anonymous and strictly confidential.

To be entered into the drawing for a $200 Visa gift card please complete survey by May 14th and enter your name, address and telephone number at the end of the survey. 

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* 1. In the following list, what do you think are the THREE (3) most serious health concerns in your community where you live? Please select three (3).

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* 2. Would you agree that your community is a “healthy community?”

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* 3. Please check up to THREE (3) lifestyle choices in your community that concern you the most.

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* 4. Please select THREE (3) of the items below that you believe are most important for a “healthy community.”

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* 5. Please check up to THREE (3) mental health issues that impact YOU AND YOUR FAMILY the most.

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* 6. Overall, how much impact do you think people like you can have in making your neighborhood or community a better place to live?

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* 7. In general, would you say your health is…?

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* 8. Does everyone in your household have health insurance?

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* 9. Does everyone in your household have dental insurance?

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* 10. If you answered “No” to questions 8 or 9, who in your household is uninsured?

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* 11. Do you have someone who you consider to be “your” doctor or health care provider?

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* 12. If you marked “No” to question 11, then where do you get health care?

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* 13. During the past three years, was there a time when you or a member of your household felt you needed health care services but did NOT get, or delayed getting service?

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* 14. If you answered “Yes” to question 13, what were the THREE (3) most important reasons why you or a family member did not receive the care you needed?

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* 15. How do you learn about health services in your community?

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* 16. What concerns you the most about health care in your community?

Please tell us about your household

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* 17. Do you Smoke Cigarettes?

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* 18. Do you Vape?

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* 19. Do you use marijuana?

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* 20. Are you aware of assistance that might be available to help people quit smoking such as telephone quit lines and local health clinic services?

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* 21. How many people 18 years and older live in your household (include yourself)?

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* 22. How many people under 18 years live in your household?

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* 23. Do you have a landline (home) telephone (not including a cell phone)?

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* 24. Do you have access to a computer at your household?

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* 25. Do you have access to the internet at your household?

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* 26. Do you have access to reliable transportation at your household?

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* 27. What is your age?

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* 28. What is your gender?

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* 29. Are you Hispanic or non-Hispanic?

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* 30. What do you consider your race? (check all that apply)

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* 31. What is your marital status?

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* 32. What is the approximate monthly income for your household before taxes?

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* 33. What is the highest level of school that you completed?

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* 34. What is your current employment status? (check all that apply)

COVID Supplemental Questions

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* 35. During the past year, was there a time when you or a member of your household felt you needed health care services but did NOT get, or delayed getting service due to COVID-19?

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* 36. In the past year, have you been sick for more than one day with an illness that included any of the following: fever, cough, sore throat, or runny or stuffy nose??

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* 37. For this illness, where did you seek medical attention? (select all that apply):

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* 38. How long after your symptoms started did you seek care?

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* 39. For this illness, were you diagnosed with COVID-19?

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* 40. Were you or anyone in your household diagnosed with COVID-19 this past year?

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* 41. Did you have access to telemedicine over this past year?

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* 42. If you answered yes to question 41, would you want to continue to utilize telemedicine healthcare services in the future?

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* 43. How do you feel that COVID-19 has affected families in your community (select all that apply):

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* 44. Due to COVID-19, do you think that there is an increased need for assistance in your community with (select all that apply):

The Coronavirus | COVID-19 can have many different impacts. How has the Coronavirus | COVID-19 impacted your household in the past year and what are the needs of your household? Select all that apply.

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* 45. Wages and Employment

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* 46. Medical and Health

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* 47. Family and Well-being

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* 48. Education and Schooling

Thank you! 

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* 49. If you'd like to be entered into the drawing to win the $200 Visa gift card, fill out your name, address and telephone number below.

0 of 49 answered
 

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