Skip to content
Healthcare survey
1.
I live in (name of town or city)
*
2.
I would participate in a health fair if it was held in or near my community
(Required.)
Yes
No
3.
What would you like to see offered at the health fair?
*
4.
I would attend a class or series on the following subjects if they were held in or near my community. Please check all that apply
(Required.)
High Blood Pressure
Heart Disease
Diabetes
COPD/Black Lung
Health Eating
Tobacco Cessation
Other (please specify)
*
5.
Do you have a primary care doctor?
(Required.)
Yes
No