Demographic Information

MHC Healthcare is conducting its 2019 Community Needs Assessment to determine how MHC can better serve you. Your input into this process is of great value to MHC, so we are requesting 10-15 minutes of your time to complete this Needs Assessment Survey. Your time is greatly appreciated!

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* 1. What is your ZIP code?

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* 2. About how long have you lived in the area?

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* 3. What sex were you assigned at birth?

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* 4. What is your current gender identity?

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* 5. What is your Sexual Orientation?

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* 6. Which of the following best represents your racial or ethnic heritage?

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* 7. What is your marital status?

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* 9. What is the predominant language spoken at home?

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* 10. Are you the primary caretaker for any child(ren)?

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* 11. Are you a Veteran?

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