Demographics

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* 1. Zip code where you live

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* 2. Zip code where you work

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* 3. Age

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* 4. Gender

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* 5. Ethnic Group

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* 6. Language spoken at home

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* 7. Is understanding the English language a problem for you?

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* 8. Are you satisfied with the health care system in Taylor County?

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* 9. What do you think are the THREE most important factors for a "Healthy Community?" (Those factors which most improve the quality of life in a community) Check only three:

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* 10. What do you think are the THREE most important "health problems" in Taylor County?

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* 11. Select the top THREE health challenges YOU face:

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* 12. Do you have school age children?

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* 13. If yes, which grades?

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* 14. Are you raising children that are your grandchildren?

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* 15. What issues do your school age children face?

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* 16. How would you rate Taylor County as a "Healthy Community?"

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* 17. How would you rate your personal health?

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* 18. Where do you go for routine healthcare?

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* 19. If you answered "I don't receive routine healthcare" to number 18, please choose all reason why below.

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* 20. How often have you used the Emergency Room in the past 12 months?

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* 21. How often have you used the Emergency Room in the past 12 months for a child in your care?

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* 22. What means of transportation do you use?

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* 23. What preventative health services do you use?

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* 24. The last time you used a health care facility in Taylor County did you feel you received enough information/education to recover?

  Yes No
Taylor Regional Hospital
Doctors Office

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* 25. In your opinion, what is the best way to address the health needs of people in Taylor County? (Please choose one)

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* 26. What group needs the most help with access to health care in Taylor County?

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* 27. Name one way to improve the health of Children?

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* 28. If the following screenings were available which ones would you be interested in doing? (Choose all that apply)

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* 29. How do you find out about community events, classes, or programs in Taylor County?

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* 30. Suggestion for classes:

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