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Healthy Towns Community Survey
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17%
About You
*
1.
Which town do you live in?
(Required.)
2.
How old are you (please tick one)?
12-18 years
19-24 years
25-44 years
45-64 years
65-84 years
85+
3.
Do you identify as Aboriginal and/or Torres Strait Islander?
Yes
No
4.
What is your gender?
Female
Male
Other identification (please specify)
5.
Which of the following do you have? (please tick all that apply)
Medicare card
Health Care Card
Veteran Affairs card
Disability pension card
Private health insurance
Aged pension card
None of the above
6.
What is your usual activity during the day? (please tick all that apply)
Work full time
Work part time
Self employed
Looking for work
Caring duties - children
Caring duties - other
Volunteer
School or studying
Retired or pensioner
