Saint Paul Catholic Newman Center; Fresno, California
General Health Ministry Needs Assessment Survey
MIND, BODY AND SPIRIT
*
1.
What health-related needs would you like to see addressed at Saint Paul Catholic Newman Center?
Select ALL that apply
(Required.)
Aging
Anxiety / Depression
Cancer
Chronic Pain
Diabetes / High Sugar Levels
Eating Disorders
Grief / Loss
Heart Disease (Heart Attack, High Cholesterol)
High blood pressure or Stroke
Memory (Dementia, Alzheimers disease)
Nutrition or physical activity
Sleeping difficulties
Trauma (Abuse - Physical, emotional or financial)
Smoking / Tobacco use
Stress
Substance Abuse
Suicide
Vaccinations
Other (please specify)
*
2.
Select your
TOP
Priority from Question #1
(Required.)
Aging
Anxiety / Depression
Cancer
Chronic Pain
Diabetes / High Sugar Levels
Eating Disorders
Grief / Loss
Heart Disease (Heart Attack, High Cholesterol)
High blood pressure or Stroke
Memory (Dementia, Alzheimers disease)
Nutrition or physical activity
Sleeping difficulties
Trauma (Abuse - Physical, emotional or financial)
Smoking / Tobacco use
Stress
Substance Abuse
Suicide
Vaccinations
Other Answer provided in Question #1
*
3.
Select your
2nd
Priority from Question #1
(Required.)
Aging
Anxiety / Depression
Cancer
Chronic Pain
Diabetes / High Sugar Levels
Eating Disorders
Grief / Loss
Heart Disease (Heart Attack, High Cholesterol)
High blood pressure or Stroke
Memory (Dementia, Alzheimers disease)
Nutrition or physical activity
Sleeping difficulties
Trauma (Abuse - Physical, emotional or financial)
Smoking / Tobacco use
Stress
Substance Abuse
Suicide
Vaccinations
Other Answer provided in Question #1
*
4.
Select your
3rd
Priority from Question #1
(Required.)
Anxiety
Depression
Exercise
Flu/Cold
Insomnia
Grief/Loss
Nutrition
Vaccinations
Sleep Difficulties
Social Skills
Smoking / Tobacco Use
Suicide
Substance Abuse
Trauma (Abuse - Physical, emotional or financial)
Other Response from question #1
*
5.
What Availibility of Resources / Programs would you like to see?
Select ALL that apply
(Required.)
Chronic /Terminal Illness
Advanced Directives
Caring for Aging Parents
Heathcare/ Health Services (Access to Care, Insurance, Health Care Decision Making)
End of Life / Hospice
Parenting Skills (Blended Families, Parenting Grandchildren
Other (please specify)
*
6.
Select your
TOP
Priority from Question #5
(Required.)
Chronic /Terminal Illness
Advanced Directives
Caring for Aging Parents
Heathcare/ Health Services (Access to Care, Insurance, Health Care Decision Making)
End of Life / Hospice
Parenting Skills (Blended Families, Parenting Grandchildren
Other comment from Question # 5
*
7.
Select your
2nd
Priority from Question #5
(Required.)
Chronic /Terminal Illness
Advanced Directives
Caring for Aging Parents
Heathcare/ Health Services (Access to Care, Insurance, Health Care Decision Making)
End of Life / Hospice
Parenting Skills (Blended Families, Parenting Grandchildren
Other comment from Question # 5
*
8.
Select your
3rd
Priority from Question #5
(Required.)
Chronic /Terminal Illness
Advanced Directives
Caring for Aging Parents
Heathcare/ Health Services (Access to Care, Insurance, Health Care Decision Making)
End of Life / Hospice
Parenting Skills (Blended Families, Parenting Grandchildren
Other comment from Question # 5
9.
Other comments that are relative to this survey?