South Shore Health Needs Assessment

This survey will take less than five minutes to complete.

South Shore Health and Wellness Inc. wishes to have the input of South Shore Communities in order to move forward with plans to establish a health and wellness centre in Crapaud. Please fill in only one survey per household. Deadline for submissions is March 12. Thanks!

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* 1. What is your postal code?

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* 2. How many people in your household are in each of these age categories?

1-11

12-19

20-39

40-59

60-99

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* 3. How many members of your household do NOT have a family physician or nurse practitioner?

4 or more

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* 4. Please check all of the services that you or a member of your household would use now or in the future if available in the South Shore area:

access to a physician or nurse practitioner

routine blood work

diabetes education

mental health services such as addiction counselling, quit smoking therapy, stress management, conflict resolution

wellness programs for seniors

asthma or COPD education

blood work for warfarin

high blood pressure education

parenting information or programs for teen mothers

nutritional education

foot care services

pap tests

physiotherapy or occupational therapy

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* 5. Where would your household members prefer to access a family physician or nurse practitioner?

Crapaud

Cornwall

Charlottetown

Summerside

Hunter River

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* 6. How often does a member of your household access a walk-in clinic or the emergency department?

once a week or more

less than once a week but more than once a month

once every 1-3 months

about twice a year

about once a year

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* 7. How often does a member of your household go to their family physician or nurse practitioner for a scheduled appointment?

once a week or more

less than once a week but more than once a month

once every 1-3 months

about twice a year

once a year or less

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* 8. If you are currently without a family physician, your words here on what you have to go through to get health care could be a powerful tool in outlining the community's needs for health services; Or, if you or your family have experienced a situation where having care in our community made an important difference in a health outcome, we would also be happy to hear your story; Finally, if you have comments or suggestions, we would welcome them here"