Thank you for taking the time to fill out this survey! Each participant who completes a survey will be entered into a drawing to win 1 of 4 $25 gift card prizes!

* 1. Geographical Information

* 2. Which of the below groups have the greatest healthcare needs not met? Please rank them in order: 1 has the most needs NOT met, where 6 has the least needs NOT met.

* 3. If you believe that the following group's health needs are NOT met, please choose which category best fits their needs. (Please only choose one answer per group)

  Access to Primary Care Preventative Health & Wellness Chronic Disease Management Health Needs Met
Children (0-12)
Teens (13-17)
Adults (18-64)
Senior Citizens (65+)
Families
Minorities

* 4. For each group, what do you feel are the greatest needs? (Please only choose one answer per group)

  Insurance Available Physicians Cost of Medication Drugs, Alcohol & Tobacco Exercise / Healthy Eating Mental Health Vaccinations Preventative Screenings
Children (0-12)
Teens (13-17)
Adults (18-64)
Senior Citizens (65+)
Families
Minorities

* 5. Are you involved in any organization/program that addresses the above group's needs in any way? (Please choose as many answers which may apply)

* 6. Do people have to travel outside of your community to have their healthcare needs met?

  Yes No
Hospital Services
Primary Care Physicians
Specialty Care Services

* 7. Overall, what general healthcare needs are NOT met in your community? (Please choose as many answers which may apply)

* 8. Has Unity Health (formerly White County Medical Center and Harris Hospital) or the Advanced Care Hospital of White County had a positive impact on your community?

* 9. What would you add to your community to make it more achievable to live a healthy lifestyle? (Please choose as many answers which many apply)

* 10. Do you have any other comments/concerns about how Unity Health (formerly White County Medical Center and Harris Hospital) or the Advanced Care Hospital of White County could improve your community?

* 11. Optional (In order to win the gift card prize, you must leave a name and way to be contacted)

Thank you! Unity Health and the Advanced Care Hospital of White County look forward to continuing our goal of making your community healthier!

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