Thank you for taking the time to fill out this survey!  Your feedback and comments are greatly appreciated!

* 1. What county do you live in?

* 2. What county do you work in? (Please choose all that apply.)

* 3. In what ways have you participated in the 2015 Healthy! Capital Counties community health needs assessment process? (Please choose all that apply.)

* 4. If you have participated in the 2015 Healthy! Capital Counties community health needs assessment process, what was your role? (Please choose all that apply.)

* 5. Please enter any comments or feedback about the 2015 Healthy! Capital Counties Community Health Profile & Health Needs Assessment below:

* 6. If you would like to speak with local health department staff regarding the 2015 Healthy! Capital Counties Community Health Profile & Health Needs Assessment, or community health improvement processes in general, please list your name and contact information (phone, email, etc.):

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