HHS Community Health Needs Assessment 2013 Question Title * 1. In what towns do you, a) live and/or b) work? a b Everett Everett a Everett b Lynnfield Lynnfield a Lynnfield b Malden Malden a Malden b Medford Medford a Medford b Melrose Melrose a Melrose b North Reading North Reading a North Reading b Reading Reading a Reading b Revere Revere a Revere b Saugus Saugus a Saugus b Stoneham Stoneham a Stoneham b Wakefield Wakefield a Wakefield b Winthrop Winthrop a Winthrop b Other Other a Other b Other (please specify) Question Title * 2. What is your gender? Male Female Transgender Question Title * 3. What is your age? 18 or younger 19-29 30-39 40-49 50-59 60-69 70-79 80 or older Question Title * 4. What is your a) ethnicity and b) race? Ethnicity Race Please answer both questions Hispanic Non-Hispanic Please answer both questions Ethnicity menu Asian/Pacific Islander Black/African American Native American/American Indian White Other Please answer both questions Race menu Other, please explain Question Title * 5. What are the main languages you speak at home? Please check all that apply. English Arabic French Haitian Creole Italian Portuguese Spanish Vietnamese Chinese Cantonese Chinese Mandarin Chinese- other dialect Other Other or Chinese other dialect (please specify) Question Title * 6. In what language do you prefer to receive your healthcare services? Please check one English Arabic French Haitian Creole Italian Portuguese Spanish Vietnamese Chinese Cantonese Chinese Mandarin Other Chinese dialect Other Other or other Chinese dialect (please specify) Question Title * 7. Have you lived in the US all of your life? Yes 1 year or less 2-5 years 6-10 years More than 10 years Next