General Health

These questions ask about you and your family's health.  These are important questions for us, so that we can design programs and activities to improve public health in Madison.  There are no right or wrong answers.  Please answer honestly.

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* 1. In general, how would you describe your health currently?

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* 2. Where do you go most often for your health care?

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* 3. How many times in the past year have you been to the Emergency Room or an Urgent Care Walk-in Clinic?

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* 4. Has a doctor, nurse, or other health care professional ever said you have any of the following health problems (check all that apply)?

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* 5. Do you take medication for any of the above checked health problems?

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* 6. Has a doctor or nurse ever told you that you were disabled?

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* 7. Has a doctor or nurse ever told you that you were overweight or obese?

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* 8. At your last medical visit, did you understand what the doctor/nurse told you?

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* 9. Do you know and understand what medications you are taking?

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* 10. If applicable, does your child(ren) have regular check-ups with a pediatrician?

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* 11. If applicable, has a doctor or nurse ever told you that your child(ren) were overweight or obese?

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* 12. Do you see a dentist at least once a year?

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* 13. Do you get the recommended screenings, i.e. Blood work, mammograms, colonoscopy, pap testing, lung cancer screening for smokers?

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* 14. Have you or anyone you know told you that they have considered suicide in the past year?

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* 15. Over the past month, how often have you been feeling down, depressed, or hopeless or having little interest or pleasure in doing things?

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