Please take a minute to complete the survey below. The purpose is to get your opinion about community health issues and quality of life. In collaboration with our public health partners in Montezuma County, we will compile this information and use it as input for the development of a community health improvement plan. Thank you for your participation.

Instructions: Listed below are 24 public health issues for our community.  Of the 24 issues listed, please select/rate the top three issues in order of importance in your life.

1 = most important 2 = 2nd most important 3 = 3rd most important

* 1. Please select/rate the top three issues in order of importance in your life.

  1 = most important 2 = 2nd most important 3 = 3rd most important
Access to exercise
Access to healthcare (e.g., dental, mental health, maternity, primary care physician, etc.)
Air Quality (e.g. asbestos, radon, etc.)
Being prepared for an emergency
Child abuse/neglect/prevention
Dental problems
Diabetes
Drinking water
Firearm-related injuries/ gun safety
Heart disease and stroke
Illegal substance use/abuse (e.g. Heroin, illegal use of prescription drugs, meth, etc.)
Infant deaths
Infectious diseases (e.g., hepatitis, TB, etc.)
Intimate partner violence
Lead poisoning
Legal substance use/abuse (e.g., alcohol, marijuana, tobacco etc.)
Mental health
Overweight/obese
Seatbelts/child safety seats
Sexually Transmitted Infection
Suicide
Unplanned/teen pregnancy
Water fluoridation
Water quality (e.g., lakes, rivers, etc.)

* 2. Based on your #1 selection, what group of people would most benefit from services?
Please select all that apply.

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