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* 1. Where do you spend most of your time?

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* 2. What are the most critical health issues facing the people of this area? Choose what you consider to be the TOP FOUR health issues from the following choices.

  Access to care Barriers to healthy choices Cancer Care for the elderly Chronic disease management (e.g., arthritis, asthma, COPD, diabetes, etc.) Heart disease / Stroke Behavioral health Obesity / Sedentary lifestyles Preventable hospital stays (e.g., dehydration, flu, pneumonia, urinary tract infection, etc.) Substance abuse Pain management
HEALTH ISSUE 1
HEALTH ISSUE 2
HEALTH ISSUE 3
HEALTH ISSUE 4

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* 3. Are there other critical health issues not listed in Question 1? List them below.

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* 4. What would improve the health of you or your family? Choose what you consider the TOP TWO BEST WAYS to improve health in this area.

  Healthy food access Free / Affordable health screenings Better / More education opportunities Free / Affordable health insurance Employment opportunities Wellness services and education Safe areas for play and walking
HOW TO IMPROVE HEALTH 1
HOW TO IMPROVE HEALTH 2

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* 5. Are there other ways to improve the health of you or your family not listed in question 3? List them below.

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* 6. What makes it difficult to access care when you need it?

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