Community Services Survey Question Title * 1. Zip Code Question Title * 2. Neighborhood Question Title * 3. Would you or your community be interested in any one of the following Mobile health vans Community health hubs (Located in a neighborhood) A combination of mobile health vans and community health hubs Other (please specify) Question Title * 4. Check all type(s) of programs you or your community may be interested in: Fitness/Wellness Homeless Services (showers, laundry, etc.) Maternal/Child Health (Mom & Baby) Mental/Behavioral Health Mobile Market (Fresh produce at a reduced cost at multiple locations) Nutrition Education Prenatal Care (Pregnancy care - for mom and baby) Primary Care (Family Doctor) Resume/Job consultation services Screenings (Blood Pressure, Body Weight, Body Mass Index, HIV, Hep C, Cholesterol, A1C) Senior Health Services Other (please specify) Question Title * 5. Where would you and/or your community normally go to seek community services? Question Title * 6. Where would you and/or your community normally go to seek health services? Question Title * 7. Would you be interested in participating/planning this type of project in the future with the University of Maryland Medical Center? Yes No Question Title * 8. If you answered yes to question #7, please complete the items below. Full Name Phone Number Email Address Done
