Your opinion is important to us!

The purpose of this survey is to get your opinion about health issues that are important in your community. New York Methodist Hospital will use the results of this survey and other information to help target health programs in your community. Please complete one survey for each adult over the age of 18. Your responses will be anonymous. Thank you for your participation.

Question Title

* 1. In what neighborhood, or ZIP code, do you live?

Question Title

* 2. What are the biggest ongoing health concerns in your community? (Please check up to 2)

Question Title

* 3. What health screenings or education/information services are most needed in your community?
(Please check up to 3)

Question Title

* 4. What prevents people in your community from getting medical treatment? (Please check up to 3)

Question Title

* 5. Does your doctor ever order a test or prescribe medicine without explaining what it’s for or what it does?

Question Title

* 6. What is your sex?

Question Title

* 7. What is your age?

Question Title

* 8. What race and/or ethnicity do you consider yourself? (Please check all that apply)

Question Title

* 9. What is your highest level of education?

Question Title

* 10. Do you currently have health insurance?

T