Community Health Needs Assessment 2016 Please be honest with your answers. Participants will not be held accountable by law for any answers on this survey. (For instance, if you answer that you use illegal drugs, we will not contact law enforcement.) Question Title * 1. How would you describe your overall health? Excellent Very Good Fair Poor Question Title * 2. Please select the top three health challenges you face. Alcohol overuse Cancer Diabetes Drug addiction Heart disease High blood pressure Joint pain or back pain Lung disease Mental health issues Overweight/obesity Stroke I do not have any health challenges Other (please specify) Question Title * 3. Where do you go for routine health care? Physician's office Public health department Emergency room Urgent care clinic Other clinic I do not receive routine health care I would not seek health care Other (please specify) Question Title * 4. Where would you go for emergency medical services if you were able to take yourself? Emergency room Urgent care clinic Physician's office Public health Other clinic I would not seek health care Other (please specify) Question Title * 5. Are there any issues that prevent you from accessing care? Cultural/religious beliefs Don't know how to find doctors Don't understand the need to see a doctor Fear (e.g., not ready to face/discuss health problem) Lack of availability of doctors Language barriers No insurance and/or unable to pay for the care No barriers Unable to pay co-pays/deductibles Transportation Other (please specify) Question Title * 6. What is needed to improve the health of your family and neighbors? Free or affordable health screenings Health insurance coverage Healthier food Job opportunities Mental health services Recreation facilities Safe places to walk/play Specialty physicians Substance abuse rehabilitation services Transportation Wellness services I don't know Other (please specify) Question Title * 7. What types of health screenings and/or services are needed to keep you and your family healthy? (Check up to five) Blood pressure Cancer Cholesterol (fats in the blood) Dental screenings Diabetes Disease outbreak prevention Drug and alcohol abuse Eating disorders Emergency preparedness Exercise/physical activity Falls prevention for the elderly Heart disease HIV/AIDS and STDs Memory loss Mental health/depression Nutrition Prenatal care Quitting smoking Routine well checkups Suicide prevention Vaccination/immunizations Weight-loss help Other (please specify) Question Title * 8. What health issues do you need education about? (Please check up to five) Blood pressure Cancer Cholesterol Dental screenings Diabetes Disease outbreak prevention Drug and alcohol abuse Eating disorders Emergency preparedness Exercise/physical therapy Falls prevention in the elderly Heart disease HIV/AIDS and STDs Mental health/depression Nutrition Prenatal care Quit smoking Routine well checkups Suicide prevention Vaccination/immunizations Other (please specify) Next