This survey will take less than five minutes. Thank you for helping us find ways to create a healthier community.
 
This survey is being conducted by HSHS St. Anthony's Memorial Hospital in Effingham.

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1. In what year were you born? (enter 4-digit birth year; for example, 1976)

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2. What is your gender?

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3. What is the highest level of education you have completed?

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4. What is your approximate average household income?

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5. Select the option(s) that best describe your race/ethnicity:

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6. What is your zip code?

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7. What is your disability status?

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8. Rank the following health concerns in order from 1 (most important health concern) to 10 (least important health concern) by dragging your choices up or down.

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9. How would you rate YOUR overall health?

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10. How would you rate the health of Effingham County?

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11. How would you rate the health of Jasper County?

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12. What do you think is/are the biggest health problems facing Effingham and Jasper counties?

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13. What is the one thing you would do to make the health of Effingham and Jasper counties better?

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