This survey is for Clinton County residents only and will take about 6 minutes to complete. It is designed to help our health department understand community needs and gaps in service. Your input will allow us to direct our services to fill these gaps.

Please answer all the survey questions to the best of your ability. Information is kept confidential. Thank you for taking the time to help us make this community a happier, healthier place to live.

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* 1. Do you live in Clinton County?

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* 2. Which Clinton County zip code do you live in?

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* 3. On a scale of 1 to 5, how would you rate your community as a safe place to live and/or raise children?

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* 4. From the following list, please rank all eight choices in order from most to least important to you, with 1 being the most important to you and 8 being the least important to you.

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* 5. From the following list, please choose three topics you would like health education on in Clinton County.

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* 6. Overall, how would you rate your physical health?

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* 7. Is an exercise space easily accessible to you?

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* 8. How many days per week do you engage in moderate to vigorous exercise for at least 30 minutes each day?

Moderate exercise examples: brisk walking, line dancing, doubles tennis, swimming leisurely, easy jogging, bicycling under 10mph, using an elliptical, yoga, etc.

Vigorous exercise examples: swimming laps, running, playing basketball/football/soccer/volleyball, heavy weightlifting, hiking uphill, jumping rope, etc.

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* 9. On a typical day, how many servings of fruits and/or vegetables do you consume?

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* 10. Do you have access to fresh fruits and vegetables near you?

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* 11. Overall, how would you rate your mental health?

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* 12. If needed, are mental/behavioral health services easily accessible to you?

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* 13. How frequently do you believe community members under 21 years of age are consuming alcohol?

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* 14. Please respond to the following statement:

Community members under the age of 21 risk harming themselves and others by consuming alcohol.

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* 15. How frequently do you believe community members under 21 years of age are using electronic smoking products including but not limited to: vape pens, vaporizers, e-pens, e-pipes, e-hookahs and/or e-cigars from brands such as Juul, Vuse, Markten, Blu and Logic?

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* 16. Please respond to the following statement:

Community members under the age of 21 risk harming themselves and others by using electronic smoking products.

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* 17. On a scale of 1 to 5, how prevalent of an issue is opioid/prescription drug misuse in Clinton County?

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* 18. Please choose the top three substances and/or drugs of use within our community.

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* 19. When you are in need of general medical attention, where do you go? (Check all that apply).

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* 20. How far do you travel to get to your primary care provider?

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* 21. Where do you obtain most of your medical/public health information?

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* 22. What type of health insurance do you have?

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* 23. Within the past year, were you able to receive needed healthcare?

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* 24. What is your gender identity?

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* 25. What age range do you fall under?

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* 26. What is your race?

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* 27. What is your highest level of education?

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* 28. Please share any additional health priorities and/or comments you may have.

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