Please take 3-5 minutes to complete the survey below. The purpose of the survey is to collect the opinions of the community about community health issues and quality of life. The information gathered from this survey will be used as input for the development of the South Shore community health assessment and community health improvement plan. Participation in this survey is voluntary and all responses are anonymous.

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* 1. What zip code do you live or work?

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* 2. How would you rate the overall health of the community

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* 3. In your opinion, what top 5 issues need to be addressed to improve the overall health of the community? (Please review all options)

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* 4. What is your age?

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* 5. What gender do you identify with?

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* 6. Do you identify as Hispanic or Latino?

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* 7. Which race(s) do you identify with? (Select all that apply)

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* 8. What is your current marital status?

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* 9. What is your annual household income?

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* 10. What is your highest level of education?

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* 11. Please share any additional comments or concerns:

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