This completely confidential 15-question survey is your chance to help us obtain resources to better your healthcare needs. Let’s make a difference together – your input will guide vital health initiatives in the Apache County (White Mountain Regional Medical Center) service area.
Complete this survey for a chance to win an Amazon gift card.

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* 1. What is your age?

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* 2. What is your home zip code?

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* 3. Are you a guardian/parent/caregiver for another individual?

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* 4. How do you prefer to receive information about healthcare services? mark all that apply.

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