Note: If you have already completed this survey with CHI Franciscan Health or Harrison Medical Center, you do NOT need to complete this survey again.

CHI Franciscan Health and Harrison's Medical Center have engaged the Kitsap Public Health District to conduct a Community Health Needs Assessment.  The Assessment draws from community voices through this survey as well as community conversations and service provider interviews.

The purpose of this survey is to find out what you think about health, healthcare and the strengths and needs of your community.   Your answers are very important to us and are anonymous - your name will not appear anywhere on this survey.

This survey is completely voluntary.  Your choice to participate will in no way affect your ability to access services.

The results of this survey will be analyzed as a group and used for planning purposes only.  Results will be shared in CHI's 2017 Community Needs Assessments to help guide the development of our services and support continuous improvement.

This is a wonderful way for you to have a voice in improving healthcare services.  Thank you for your participation!

* 1. How satisfied are you with the quality of life in your community?

* 2. How socially connected do you feel to your community?  Connected means being socially involved with others in your community.

* 3. What do you think are the THREE most important things that make a healthy community?
(Please pick 3.)

* 4. Which of the following do you wish were more present in your community?
(Please pick your top 3.)

* 5. What THREE things cause the biggest problems to your community's overall health?
(Please pick 3.)

* 6. What THREE things cause the biggest problems to children and youth in your community?
(Please pick 3.)

* 7. How would you rate your community's health overall?

* 8. What do you think is the most important way to work on health problems in your community?

* 9. How satisfied are you with health care in your community?

* 10. What has kept you from getting the healthcare you need?

* 11. What can health care providers, hospitals or clinics do to help make communities healthier?

In this last section we have some questions about you.

* 12. What is your gender?

* 13. What is your age?

* 14. Do you have a child in the household under the age of 18?

* 15. Which race do you identify as? (Please choose all that apply)

* 16. In what part of Kitsap County do you live?

* 17. Do you identify as Hispanic or Latino?

* 18. How long have you lived in Kitsap County?

* 19. In what zip code do you live?

* 20. What language do you mainly speak at home?

* 21. Is there anything else you would like to share?