If you have any questions or need assistance with filling out the survey, please contact Tami Conn at tconn@health.nv.gov or 775-684-4023 or Kagan Griffin at kgriffin@health.nv.gov or 775-461-6600.

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* 1. What do you think are the top THREE things currently in your community that benefit women, children, and families? These are the things that you feel are a strength in your community, and are available, accessible, affordable, and/or high quality. Select one to three options.

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* 2. What do you think are the top THREE things in your community LACKING OR MISSING that benefit women, children, and families? These are the things that you feel need improvement in your community, and are not available, accessible, affordable, and/or high quality. Select one to three options.

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* 3. What do you think are the THREE most important health problems/health issues in the community where you live for WOMEN OF REPRODUCTIVE AGE (15 TO 44 YEARS OF AGE)?

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* 4. What do you think are the THREE most important health problems/health issues in the community where you live for PREGNANT WOMEN AND POST-PARTUM WOMEN?

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* 5. What do you think are the THREE most important health problems/health issues in the community where you live for NEWBORNS AND INFANTS (BIRTH UP TO 1 YEAR OF AGE)?

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* 6. What do you think are the THREE most important health problems/health issues in the community where you live for YOUNG CHILDREN (1 to 5 YEARS OF AGE)?

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* 7. What do you think are the What are the THREE most important health problems/health issues in the community where you live for CHILDREN (6 TO 11 YEARS OF AGE)?

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* 8. What do you think are the What are the THREE most important health problems/health issues in the community where you live for ADOLESCENTS/YOUNG ADULTS (12 TO 21 YEARS OF AGE)?

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* 9. What do you think are the THREE most important health problems/health issues in the community where you live for CHILDREN WITH SPECIAL HEALTH CARE NEEDS (BIRTH TO 21 YEARS OF AGE)?

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* 10. Do you have any general feedback for Nevada Title V Maternal and Child Health Program?

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