The purpose of this survey is to get your opinion about health issues that are important in your community. Together, the County Departments of Health and hospitals throughout Long Island will use the results of this survey and other information to help target health programs in your community. Please complete only one survey per adult 18 years or older. Your survey responses are anonymous. Thank you for your participation.

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* 1. What are the biggest ongoing health concerns in THE COMMUNITY WHERE YOU LIVE? (please check up to 3)

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* 2. What are the biggest ongoing health concerns for YOURSELF? (Please check up to 3)

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

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* 4. Which of the following is MOST needed to improve the health of your community? (Please check up to 3)

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

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* 6. Where do you and your family get most of your health information? (Check all that apply)

For statistical purposes only, please complete the following:

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* 7. I identify as:

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* 8. What is your age?

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* 9. Zip code where you live:

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* 10. Town where you live:

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* 11. What race do you consider yourself?

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* 12. Are you Hispanic or Latino?

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* 13. What language do you speak when you are at home? (select all that apply)

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* 14. What is your annual household income from all sources?

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* 15. What is your highest level of education?

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* 16. What is your current employment status?

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* 17. Do you currently have health insurance?

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* 18. Do you have a smart phone?

All non-profit hospitals on Long Island offer financial assistance for emergency and medically necessary care to individuals who are unable to pay for all or a portion of their care. To obtain information on financial assistance offered at each Long Island hospital, please visit the individual hospital’s website.

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