Tioga County Public Health Care Question Title * 1. Select your top THREE health challenges Cancer Diabetes Overweight/Obesity High Blood Pressure Joint and/or Back Pain Stroke Heart Disease Mental Health Issues Alcohol Overuse Drug Addiction No Health Challenges Other (please specify) Question Title * 2. Where do you go for routine health care? Physician's Office Health Department Emergency Room Urgent Care Clinic Other Clinic I do not receive health care Other Question Title * 3. Are there any issues that prevent you from accessing care? (check all that apply) Cultural/Religious beliefs Do not know how to find providers Lack of availability of providers No insurance/unable to pay for care Unable to pay co-pays/deductibles Transportation Other (please specify) Question Title * 4. Which of the following have you had in the past 12 months? (check all that apply) Mammogram and/or Pap Smear Prostate cancer screening Flu shot Colon/Rectal exam Blood Pressure check Skin cancer screening Cholesterol screening Vision and/or hearing screening Cardiovascular screening Dental cleaning/x-rays Physical exam None of the Above Question Title * 5. Do you have health insurance? Yes No No, but I did in the past Question Title * 6. If yes or have in the past, please state which insurance(s): Question Title * 7. Would you benefit from a conveniently located, low-cost clinic in Tioga County? Yes, I do not have any healthcare options No, I already see a primary care provider Unsure Question Title * 8. Please select the Public Health services in Tioga County you and/or your family have been involved with: Children with Special Healthcare Needs Child Passenger Safety Rabies Clinic Healthy Neighborhoods Tioga Dental Services Vaccines None of the Above Question Title * 9. If you would like more information about these programs, please provide your email and/or phone number below Question Title * 10. What zip code do you live in? Done