Community Health Needs Assessment | NorthCrest Medical Center 

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* 1. What is your gender?

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* 2. What age range do you fall in?

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* 3. What is your marital status?

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* 4. What is your ethnicity?

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* 5. What is your household income?

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* 6. What zip code do you live in?

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* 7. What is your employment status?

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* 8. What is your highest level of completed education?

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* 9. In general how would you rate your overall health?

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* 10. How often do you exercise per week?

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* 11. What do you do most often for exercise?

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* 12. What do you see as important health issues facing you and your family? Please rate each between 1 and 5.

  1 - Don't Know/Not Applicable 2 - Not Important to my Family 3 - Slightly Important to my Family 4 - Important to my Family 5 - Very Important to my Family
Affordable Healthcare Insurance
Obesity (Over Weight)
HIV
STD/STI - Sexually Transmitted Disease/Infection (HPV, Chlamydia, Gonorrhea, etc.)
Cancer
Diabetes (Adult)
Diabetes (Pediatric)
Drug and Substance Abuse
Domestic Violence
Mental Health Issues (Anxiety, Behavior, Depression, Suicide)
Access to Mental Health Treatment
Dental Care
Eye Care
Foot Care
Heart Disease
Stroke
High Blood Pressure
Transportation for Medical Needs
Teen Pregnancy
Access to birth control
Affordable Prescription Drugs
Lack of Equipment Resource for Home Care
Women's healthcare
Child healthcare
Elder care
Smoking/Tobacco Use
Preventive Care (Health Screenings)
Nutrition/diet/smart grocery shopping/cooking

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* 13. Which substance is the biggest threat to our community?

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* 14. How many people do you know that use/abuse illegal drugs? 

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* 15. Are you and your family able to find and access the healthcare resources you need?

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* 16. If you answered "No" to #15, what issues are you and your family facing?

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* 17. What healthcare services, programs or organizations are needed in the community?

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* 18. How would you like to receive FREE health education/information?

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