If you are at least 18 years of age, please take a few minutes to complete the survey below. The purpose of this survey is to get your opinion about community health issues. All responses will remain anonymous.

Question Title

* On a scale of 1 to 5, how has COVID-19 negatively affected you and your family in the following areas:

  1 - Not Much 2 - Somewhat 3- Moderately 4 - Significantly 5 - Severely
Physical Health
Mental Health
Financial Health

Question Title

* On a scale of 1 to 5, how has COVID-19 negatively affected your community in the following areas:

  1 - Not Much 2 - Somewhat 3- Moderately 4 - Significantly 5 - Severely
Physical Health
Mental Health
Financial Health

Question Title

* Please select up to 10 health issues that are most important to you and your family.

Question Title

* What health issues are most important to your community? Please select up to ten.

Question Title

* Do you know who to contact if you need assistance with the services below?

  Yes No Unsure
Food
Health Insurance
Housing
Medical Health
Mental Health
Transportation

Question Title

* During this ongoing pandemic, what organizations have been most helpful to you?

0 of 30 answered
 

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