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!

* 1. What is your postal code?

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

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

* 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:

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

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

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

* 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"