Healthy Acadia and Mount Desert Island Hospital are seeking input from community members across Hancock County to assess the health needs of our communities. The information will be used to create a community health plan to improve our overall health. This survey should only take about 10 minutes to complete.

Answers to all questions are optional. For Questions 3-8, please use as many response boxes as you need; you are not required to provide a response in every box.

If you have questions or comments about this survey or wish to be involved in more in-depth planning efforts, please contact Maria Donahue at maria@healthyacadia.org or 207-667-7171. The survey will be open through October 31, 2015.

Thank you for participating in this survey. Your feedback is very important to us.

* 1. Today's Date:


* 2. What is "your community" in Hancock County? For this survey, "your community" could be a town (e.g. Bass Harbor, Orland, Brooksville, Frenchboro) or a region (e.g. Bucksport Bay, Blue Hill Peninsula, Mt. Desert Island). It could be your community of residence, work or other involvement.

* 3. With which organizations are you affiliated, either through work, volunteer efforts, or other community involvement (e.g. where do you work and/or volunteer?)?

* 4. What do you like most about "your community"?

* 5. What would you say are some of the characteristics of a "healthy community"?

* 6. What are the assets or strengths of "your community", things that contribute most to your idea of a healthy community?

* 7. Are there some things that get in the way of "your community" living up to your idea of a healthy community? What concerns do you have, or concerns that you hear others express?

* 8. Are there specific ideas or projects that you would like to see accomplished, to make us a healthier community?

* 9. Name:

* 10. Age:

* 11. Gender:

* 12. Where do you receive most of your health care services?

* 13. What is your residential zip code?