The Allegany County Health Planning Coalition is assessing the health needs of our community and would like your input. Please take a few minutes to respond to the following questions. Thank you!

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* 1. What are the causes of poor health in our community? Please check all that apply.

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* 2. How would you rank the importance of these four categories for improving health, with 1 being the most important and 4 being less of a priority?

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* 3. What services/resources are needed in our community?

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* 4. In what town do you live?

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* 5. What is your age?

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* 6. What is your highest level of education?

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* 7. If you would like to be contacted to obtain more information, please add your name and email address or phone number below.

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