Public Social Services Plan Survey - Town of Athol

Town of Athol - Public Social Services Planning Survey

The Town of Athol is conducting a health-related survey of the community's inhabitants. The survey is anonymous. Information gathered will be used to complete a Public Social Services Plan. This plan will be used to guide future decision-making related to addressing human services needs in Athol. All public input is welcome and encouraged. Multiple members from each household are encouraged to take this survey. Please help your municipal leaders with this planning process. The survey questions may be accessed via the link and QR code, provided below. The estimated time to complete this survey is under five minutes.

Question Title

* 1. Do you use a primary care (i.e. family) doctor for most of your routine health care?
(If Yes, skip to question #3)

Yes

Question Title

* 2. If you responded "No" in Question #1, then what kind of medical provider do you use for routine care?

Emergency Department

Urgent Care

Community Health Center

Specialist

Other (please specify)

Question Title

* 3. The following list includes amenities identified in your community as those that have some impact (positive or negative) on the health and well-being of the overall community. Please rank each based on how YOU BELIEVE they impact the health and well being of the overall community.

	Negatively	Somewhat Negatively	Neither Positive or Negative	Somewhat Positively	Positively	Not Applicable
Healthcare Service, Athol Hospital	Healthcare Service, Athol Hospital Negatively	Healthcare Service, Athol Hospital Somewhat Negatively	Healthcare Service, Athol Hospital Neither Positive or Negative	Healthcare Service, Athol Hospital Somewhat Positively	Healthcare Service, Athol Hospital Positively	Healthcare Service, Athol Hospital Not Applicable
Healthcare Service, Urgent Care Center, Athol	Healthcare Service, Urgent Care Center, Athol Negatively	Healthcare Service, Urgent Care Center, Athol Somewhat Negatively	Healthcare Service, Urgent Care Center, Athol Neither Positive or Negative	Healthcare Service, Urgent Care Center, Athol Somewhat Positively	Healthcare Service, Urgent Care Center, Athol Positively	Healthcare Service, Urgent Care Center, Athol Not Applicable
Healthcare Service, Other Medical Facilities or Offices	Healthcare Service, Other Medical Facilities or Offices Negatively	Healthcare Service, Other Medical Facilities or Offices Somewhat Negatively	Healthcare Service, Other Medical Facilities or Offices Neither Positive or Negative	Healthcare Service, Other Medical Facilities or Offices Somewhat Positively	Healthcare Service, Other Medical Facilities or Offices Positively	Healthcare Service, Other Medical Facilities or Offices Not Applicable
Cultural Asset, Library	Cultural Asset, Library Negatively	Cultural Asset, Library Somewhat Negatively	Cultural Asset, Library Neither Positive or Negative	Cultural Asset, Library Somewhat Positively	Cultural Asset, Library Positively	Cultural Asset, Library Not Applicable
Cultural Asset, Performing Arts Spaces and/or Organizations	Cultural Asset, Performing Arts Spaces and/or Organizations Negatively	Cultural Asset, Performing Arts Spaces and/or Organizations Somewhat Negatively	Cultural Asset, Performing Arts Spaces and/or Organizations Neither Positive or Negative	Cultural Asset, Performing Arts Spaces and/or Organizations Somewhat Positively	Cultural Asset, Performing Arts Spaces and/or Organizations Positively	Cultural Asset, Performing Arts Spaces and/or Organizations Not Applicable
Cultural Asset, Millers River Environmental Center	Cultural Asset, Millers River Environmental Center Negatively	Cultural Asset, Millers River Environmental Center Somewhat Negatively	Cultural Asset, Millers River Environmental Center Neither Positive or Negative	Cultural Asset, Millers River Environmental Center Somewhat Positively	Cultural Asset, Millers River Environmental Center Positively	Cultural Asset, Millers River Environmental Center Not Applicable
Cultural Asset, Public Spaces	Cultural Asset, Public Spaces Negatively	Cultural Asset, Public Spaces Somewhat Negatively	Cultural Asset, Public Spaces Neither Positive or Negative	Cultural Asset, Public Spaces Somewhat Positively	Cultural Asset, Public Spaces Positively	Cultural Asset, Public Spaces Not Applicable
Recreational Asset, YMCA	Recreational Asset, YMCA Negatively	Recreational Asset, YMCA Somewhat Negatively	Recreational Asset, YMCA Neither Positive or Negative	Recreational Asset, YMCA Somewhat Positively	Recreational Asset, YMCA Positively	Recreational Asset, YMCA Not Applicable
Recreational Asset, School-based Athletics Programs	Recreational Asset, School-based Athletics Programs Negatively	Recreational Asset, School-based Athletics Programs Somewhat Negatively	Recreational Asset, School-based Athletics Programs Neither Positive or Negative	Recreational Asset, School-based Athletics Programs Somewhat Positively	Recreational Asset, School-based Athletics Programs Positively	Recreational Asset, School-based Athletics Programs Not Applicable
Recreational Asset, Walking/Biking/Boating Trails	Recreational Asset, Walking/Biking/Boating Trails Negatively	Recreational Asset, Walking/Biking/Boating Trails Somewhat Negatively	Recreational Asset, Walking/Biking/Boating Trails Neither Positive or Negative	Recreational Asset, Walking/Biking/Boating Trails Somewhat Positively	Recreational Asset, Walking/Biking/Boating Trails Positively	Recreational Asset, Walking/Biking/Boating Trails Not Applicable
Food System Asset, Full-Service Grocery Stores	Food System Asset, Full-Service Grocery Stores Negatively	Food System Asset, Full-Service Grocery Stores Somewhat Negatively	Food System Asset, Full-Service Grocery Stores Neither Positive or Negative	Food System Asset, Full-Service Grocery Stores Somewhat Positively	Food System Asset, Full-Service Grocery Stores Positively	Food System Asset, Full-Service Grocery Stores Not Applicable
Food System Asset, Community Gardens	Food System Asset, Community Gardens Negatively	Food System Asset, Community Gardens Somewhat Negatively	Food System Asset, Community Gardens Neither Positive or Negative	Food System Asset, Community Gardens Somewhat Positively	Food System Asset, Community Gardens Positively	Food System Asset, Community Gardens Not Applicable
Food System Asset, Farmer's Markets	Food System Asset, Farmer's Markets Negatively	Food System Asset, Farmer's Markets Somewhat Negatively	Food System Asset, Farmer's Markets Neither Positive or Negative	Food System Asset, Farmer's Markets Somewhat Positively	Food System Asset, Farmer's Markets Positively	Food System Asset, Farmer's Markets Not Applicable
Food System Asset, Food Cooperative	Food System Asset, Food Cooperative Negatively	Food System Asset, Food Cooperative Somewhat Negatively	Food System Asset, Food Cooperative Neither Positive or Negative	Food System Asset, Food Cooperative Somewhat Positively	Food System Asset, Food Cooperative Positively	Food System Asset, Food Cooperative Not Applicable
Public Safety Asset, Police, Fire and EMT services	Public Safety Asset, Police, Fire and EMT services Negatively	Public Safety Asset, Police, Fire and EMT services Somewhat Negatively	Public Safety Asset, Police, Fire and EMT services Neither Positive or Negative	Public Safety Asset, Police, Fire and EMT services Somewhat Positively	Public Safety Asset, Police, Fire and EMT services Positively	Public Safety Asset, Police, Fire and EMT services Not Applicable
Public Safety Asset, Environmental Protection Agencies	Public Safety Asset, Environmental Protection Agencies Negatively	Public Safety Asset, Environmental Protection Agencies Somewhat Negatively	Public Safety Asset, Environmental Protection Agencies Neither Positive or Negative	Public Safety Asset, Environmental Protection Agencies Somewhat Positively	Public Safety Asset, Environmental Protection Agencies Positively	Public Safety Asset, Environmental Protection Agencies Not Applicable
Employment Asset, Major Employers	Employment Asset, Major Employers Negatively	Employment Asset, Major Employers Somewhat Negatively	Employment Asset, Major Employers Neither Positive or Negative	Employment Asset, Major Employers Somewhat Positively	Employment Asset, Major Employers Positively	Employment Asset, Major Employers Not Applicable
Employment Asset, Small Employers	Employment Asset, Small Employers Negatively	Employment Asset, Small Employers Somewhat Negatively	Employment Asset, Small Employers Neither Positive or Negative	Employment Asset, Small Employers Somewhat Positively	Employment Asset, Small Employers Positively	Employment Asset, Small Employers Not Applicable
Employment Asset, Unemployment and Job Placement Services	Employment Asset, Unemployment and Job Placement Services Negatively	Employment Asset, Unemployment and Job Placement Services Somewhat Negatively	Employment Asset, Unemployment and Job Placement Services Neither Positive or Negative	Employment Asset, Unemployment and Job Placement Services Somewhat Positively	Employment Asset, Unemployment and Job Placement Services Positively	Employment Asset, Unemployment and Job Placement Services Not Applicable
Transportation Asset, Public Transportation Provider - MART or FRTA	Transportation Asset, Public Transportation Provider - MART or FRTA Negatively	Transportation Asset, Public Transportation Provider - MART or FRTA Somewhat Negatively	Transportation Asset, Public Transportation Provider - MART or FRTA Neither Positive or Negative	Transportation Asset, Public Transportation Provider - MART or FRTA Somewhat Positively	Transportation Asset, Public Transportation Provider - MART or FRTA Positively	Transportation Asset, Public Transportation Provider - MART or FRTA Not Applicable
Transportation Asset, Uber, Lyft, or other Ridesharing Service	Transportation Asset, Uber, Lyft, or other Ridesharing Service Negatively	Transportation Asset, Uber, Lyft, or other Ridesharing Service Somewhat Negatively	Transportation Asset, Uber, Lyft, or other Ridesharing Service Neither Positive or Negative	Transportation Asset, Uber, Lyft, or other Ridesharing Service Somewhat Positively	Transportation Asset, Uber, Lyft, or other Ridesharing Service Positively	Transportation Asset, Uber, Lyft, or other Ridesharing Service Not Applicable
Transportation Asset, Any Other Health Visit Transportation Service (non-MART, non-FRTA, non-ridesharing service)	Transportation Asset, Any Other Health Visit Transportation Service (non-MART, non-FRTA, non-ridesharing service) Negatively	Transportation Asset, Any Other Health Visit Transportation Service (non-MART, non-FRTA, non-ridesharing service) Somewhat Negatively	Transportation Asset, Any Other Health Visit Transportation Service (non-MART, non-FRTA, non-ridesharing service) Neither Positive or Negative	Transportation Asset, Any Other Health Visit Transportation Service (non-MART, non-FRTA, non-ridesharing service) Somewhat Positively	Transportation Asset, Any Other Health Visit Transportation Service (non-MART, non-FRTA, non-ridesharing service) Positively	Transportation Asset, Any Other Health Visit Transportation Service (non-MART, non-FRTA, non-ridesharing service) Not Applicable
Housing Asset, Homeless Prevention and Housing Organizations	Housing Asset, Homeless Prevention and Housing Organizations Negatively	Housing Asset, Homeless Prevention and Housing Organizations Somewhat Negatively	Housing Asset, Homeless Prevention and Housing Organizations Neither Positive or Negative	Housing Asset, Homeless Prevention and Housing Organizations Somewhat Positively	Housing Asset, Homeless Prevention and Housing Organizations Positively	Housing Asset, Homeless Prevention and Housing Organizations Not Applicable
Housing Asset, Home Improvement and/or Weatherization Program(s)	Housing Asset, Home Improvement and/or Weatherization Program(s) Negatively	Housing Asset, Home Improvement and/or Weatherization Program(s) Somewhat Negatively	Housing Asset, Home Improvement and/or Weatherization Program(s) Neither Positive or Negative	Housing Asset, Home Improvement and/or Weatherization Program(s) Somewhat Positively	Housing Asset, Home Improvement and/or Weatherization Program(s) Positively	Housing Asset, Home Improvement and/or Weatherization Program(s) Not Applicable
Educational Asset, Childcare and Preschool Provider(s)	Educational Asset, Childcare and Preschool Provider(s) Negatively	Educational Asset, Childcare and Preschool Provider(s) Somewhat Negatively	Educational Asset, Childcare and Preschool Provider(s) Neither Positive or Negative	Educational Asset, Childcare and Preschool Provider(s) Somewhat Positively	Educational Asset, Childcare and Preschool Provider(s) Positively	Educational Asset, Childcare and Preschool Provider(s) Not Applicable
Educational Asset, K-12 School District (Athol-Royalston)	Educational Asset, K-12 School District (Athol-Royalston) Negatively	Educational Asset, K-12 School District (Athol-Royalston) Somewhat Negatively	Educational Asset, K-12 School District (Athol-Royalston) Neither Positive or Negative	Educational Asset, K-12 School District (Athol-Royalston) Somewhat Positively	Educational Asset, K-12 School District (Athol-Royalston) Positively	Educational Asset, K-12 School District (Athol-Royalston) Not Applicable
Educational Asset, School District (Outside of Athol Royalston)	Educational Asset, School District (Outside of Athol Royalston) Negatively	Educational Asset, School District (Outside of Athol Royalston) Somewhat Negatively	Educational Asset, School District (Outside of Athol Royalston) Neither Positive or Negative	Educational Asset, School District (Outside of Athol Royalston) Somewhat Positively	Educational Asset, School District (Outside of Athol Royalston) Positively	Educational Asset, School District (Outside of Athol Royalston) Not Applicable
Educational Asset, Colleges and Universities	Educational Asset, Colleges and Universities Negatively	Educational Asset, Colleges and Universities Somewhat Negatively	Educational Asset, Colleges and Universities Neither Positive or Negative	Educational Asset, Colleges and Universities Somewhat Positively	Educational Asset, Colleges and Universities Positively	Educational Asset, Colleges and Universities Not Applicable
Organizational Asset, Informal Groups and Meetings	Organizational Asset, Informal Groups and Meetings Negatively	Organizational Asset, Informal Groups and Meetings Somewhat Negatively	Organizational Asset, Informal Groups and Meetings Neither Positive or Negative	Organizational Asset, Informal Groups and Meetings Somewhat Positively	Organizational Asset, Informal Groups and Meetings Positively	Organizational Asset, Informal Groups and Meetings Not Applicable
Organizational Asset, Multi-Sector Coalitions	Organizational Asset, Multi-Sector Coalitions Negatively	Organizational Asset, Multi-Sector Coalitions Somewhat Negatively	Organizational Asset, Multi-Sector Coalitions Neither Positive or Negative	Organizational Asset, Multi-Sector Coalitions Somewhat Positively	Organizational Asset, Multi-Sector Coalitions Positively	Organizational Asset, Multi-Sector Coalitions Not Applicable
Organizational Asset, Local Charities	Organizational Asset, Local Charities Negatively	Organizational Asset, Local Charities Somewhat Negatively	Organizational Asset, Local Charities Neither Positive or Negative	Organizational Asset, Local Charities Somewhat Positively	Organizational Asset, Local Charities Positively	Organizational Asset, Local Charities Not Applicable
Organizational Asset, North Quabbin Community Coalition	Organizational Asset, North Quabbin Community Coalition Negatively	Organizational Asset, North Quabbin Community Coalition Somewhat Negatively	Organizational Asset, North Quabbin Community Coalition Neither Positive or Negative	Organizational Asset, North Quabbin Community Coalition Somewhat Positively	Organizational Asset, North Quabbin Community Coalition Positively	Organizational Asset, North Quabbin Community Coalition Not Applicable
Organizational/Municipal Asset, Senior Center	Organizational/Municipal Asset, Senior Center Negatively	Organizational/Municipal Asset, Senior Center Somewhat Negatively	Organizational/Municipal Asset, Senior Center Neither Positive or Negative	Organizational/Municipal Asset, Senior Center Somewhat Positively	Organizational/Municipal Asset, Senior Center Positively	Organizational/Municipal Asset, Senior Center Not Applicable
Organizational Asset, Salvation Army	Organizational Asset, Salvation Army Negatively	Organizational Asset, Salvation Army Somewhat Negatively	Organizational Asset, Salvation Army Neither Positive or Negative	Organizational Asset, Salvation Army Somewhat Positively	Organizational Asset, Salvation Army Positively	Organizational Asset, Salvation Army Not Applicable
Fraternal Organization, Freemasons	Fraternal Organization, Freemasons Negatively	Fraternal Organization, Freemasons Somewhat Negatively	Fraternal Organization, Freemasons Neither Positive or Negative	Fraternal Organization, Freemasons Somewhat Positively	Fraternal Organization, Freemasons Positively	Fraternal Organization, Freemasons Not Applicable
Fraternal Organization, Order of Eagles	Fraternal Organization, Order of Eagles Negatively	Fraternal Organization, Order of Eagles Somewhat Negatively	Fraternal Organization, Order of Eagles Neither Positive or Negative	Fraternal Organization, Order of Eagles Somewhat Positively	Fraternal Organization, Order of Eagles Positively	Fraternal Organization, Order of Eagles Not Applicable
Fraternal Organization, Veterans of Foreign Wars	Fraternal Organization, Veterans of Foreign Wars Negatively	Fraternal Organization, Veterans of Foreign Wars Somewhat Negatively	Fraternal Organization, Veterans of Foreign Wars Neither Positive or Negative	Fraternal Organization, Veterans of Foreign Wars Somewhat Positively	Fraternal Organization, Veterans of Foreign Wars Positively	Fraternal Organization, Veterans of Foreign Wars Not Applicable
Fraternal Organization, American Legion	Fraternal Organization, American Legion Negatively	Fraternal Organization, American Legion Somewhat Negatively	Fraternal Organization, American Legion Neither Positive or Negative	Fraternal Organization, American Legion Somewhat Positively	Fraternal Organization, American Legion Positively	Fraternal Organization, American Legion Not Applicable

Other (please specify)

Question Title

* 4. In past surveys, community members identified common themes or issues such as those listed, below. How have these issues "changed" FOR YOU PERSONALLY over the past few years?

	Worsened a Great Deal	Worsened Somewhat	Neither Improved or Worsened	Improved Somewhat	Improved a Great Deal	Not Applicable
Cost of Accessing or Utilizing Health Care	Cost of Accessing or Utilizing Health Care Worsened a Great Deal	Cost of Accessing or Utilizing Health Care Worsened Somewhat	Cost of Accessing or Utilizing Health Care Neither Improved or Worsened	Cost of Accessing or Utilizing Health Care Improved Somewhat	Cost of Accessing or Utilizing Health Care Improved a Great Deal	Cost of Accessing or Utilizing Health Care Not Applicable
Language and Cultural Barriers	Language and Cultural Barriers Worsened a Great Deal	Language and Cultural Barriers Worsened Somewhat	Language and Cultural Barriers Neither Improved or Worsened	Language and Cultural Barriers Improved Somewhat	Language and Cultural Barriers Improved a Great Deal	Language and Cultural Barriers Not Applicable
Mental Health, Depression, Suicide and Stress	Mental Health, Depression, Suicide and Stress Worsened a Great Deal	Mental Health, Depression, Suicide and Stress Worsened Somewhat	Mental Health, Depression, Suicide and Stress Neither Improved or Worsened	Mental Health, Depression, Suicide and Stress Improved Somewhat	Mental Health, Depression, Suicide and Stress Improved a Great Deal	Mental Health, Depression, Suicide and Stress Not Applicable
Substance Abuse	Substance Abuse Worsened a Great Deal	Substance Abuse Worsened Somewhat	Substance Abuse Neither Improved or Worsened	Substance Abuse Improved Somewhat	Substance Abuse Improved a Great Deal	Substance Abuse Not Applicable
Social Isolation	Social Isolation Worsened a Great Deal	Social Isolation Worsened Somewhat	Social Isolation Neither Improved or Worsened	Social Isolation Improved Somewhat	Social Isolation Improved a Great Deal	Social Isolation Not Applicable
Transportation	Transportation Worsened a Great Deal	Transportation Worsened Somewhat	Transportation Neither Improved or Worsened	Transportation Improved Somewhat	Transportation Improved a Great Deal	Transportation Not Applicable
Unemployment and Poverty	Unemployment and Poverty Worsened a Great Deal	Unemployment and Poverty Worsened Somewhat	Unemployment and Poverty Neither Improved or Worsened	Unemployment and Poverty Improved Somewhat	Unemployment and Poverty Improved a Great Deal	Unemployment and Poverty Not Applicable
Chronic Conditions (i.e. Diabetes and Heart Disease, etc.)	Chronic Conditions (i.e. Diabetes and Heart Disease, etc.) Worsened a Great Deal	Chronic Conditions (i.e. Diabetes and Heart Disease, etc.) Worsened Somewhat	Chronic Conditions (i.e. Diabetes and Heart Disease, etc.) Neither Improved or Worsened	Chronic Conditions (i.e. Diabetes and Heart Disease, etc.) Improved Somewhat	Chronic Conditions (i.e. Diabetes and Heart Disease, etc.) Improved a Great Deal	Chronic Conditions (i.e. Diabetes and Heart Disease, etc.) Not Applicable
Cancer	Cancer Worsened a Great Deal	Cancer Worsened Somewhat	Cancer Neither Improved or Worsened	Cancer Improved Somewhat	Cancer Improved a Great Deal	Cancer Not Applicable
Environmental Conditions (i.e. Water and air pollution, etc.)	Environmental Conditions (i.e. Water and air pollution, etc.) Worsened a Great Deal	Environmental Conditions (i.e. Water and air pollution, etc.) Worsened Somewhat	Environmental Conditions (i.e. Water and air pollution, etc.) Neither Improved or Worsened	Environmental Conditions (i.e. Water and air pollution, etc.) Improved Somewhat	Environmental Conditions (i.e. Water and air pollution, etc.) Improved a Great Deal	Environmental Conditions (i.e. Water and air pollution, etc.) Not Applicable
Violence and Public Safety	Violence and Public Safety Worsened a Great Deal	Violence and Public Safety Worsened Somewhat	Violence and Public Safety Neither Improved or Worsened	Violence and Public Safety Improved Somewhat	Violence and Public Safety Improved a Great Deal	Violence and Public Safety Not Applicable
Oral Health	Oral Health Worsened a Great Deal	Oral Health Worsened Somewhat	Oral Health Neither Improved or Worsened	Oral Health Improved Somewhat	Oral Health Improved a Great Deal	Oral Health Not Applicable
Coronavirus 2019 ("COVID-19")	Coronavirus 2019 ("COVID-19") Worsened a Great Deal	Coronavirus 2019 ("COVID-19") Worsened Somewhat	Coronavirus 2019 ("COVID-19") Neither Improved or Worsened	Coronavirus 2019 ("COVID-19") Improved Somewhat	Coronavirus 2019 ("COVID-19") Improved a Great Deal	Coronavirus 2019 ("COVID-19") Not Applicable
Housing Costs	Housing Costs Worsened a Great Deal	Housing Costs Worsened Somewhat	Housing Costs Neither Improved or Worsened	Housing Costs Improved Somewhat	Housing Costs Improved a Great Deal	Housing Costs Not Applicable
Job Security	Job Security Worsened a Great Deal	Job Security Worsened Somewhat	Job Security Neither Improved or Worsened	Job Security Improved Somewhat	Job Security Improved a Great Deal	Job Security Not Applicable

Other (please specify)

Question Title

* 5. If you need more information on a health topic, FROM WHOM do you obtain information?

	Never	Sometimes	Most of the TIme	All of the time
Primary Care Physician (PCP)	Primary Care Physician (PCP) Never	Primary Care Physician (PCP) Sometimes	Primary Care Physician (PCP) Most of the TIme	Primary Care Physician (PCP) All of the time
Nurse	Nurse Never	Nurse Sometimes	Nurse Most of the TIme	Nurse All of the time
Commercial Advertising	Commercial Advertising Never	Commercial Advertising Sometimes	Commercial Advertising Most of the TIme	Commercial Advertising All of the time
Online Medical Resources	Online Medical Resources Never	Online Medical Resources Sometimes	Online Medical Resources Most of the TIme	Online Medical Resources All of the time
Council On Aging or Senior Center	Council On Aging or Senior Center Never	Council On Aging or Senior Center Sometimes	Council On Aging or Senior Center Most of the TIme	Council On Aging or Senior Center All of the time
Municipal Health Agent	Municipal Health Agent Never	Municipal Health Agent Sometimes	Municipal Health Agent Most of the TIme	Municipal Health Agent All of the time
Teacher	Teacher Never	Teacher Sometimes	Teacher Most of the TIme	Teacher All of the time
Family	Family Never	Family Sometimes	Family Most of the TIme	Family All of the time
Friends	Friends Never	Friends Sometimes	Friends Most of the TIme	Friends All of the time

Other (please specify)

Question Title

* 6. If you need more information on a health topic and obtain it from one or more sources identified in the previous question, HOW do you obtain the information? (Select as many as apply to you)

In person communication

Phone

Heywood Portal (or other medical care provider's patient-provider communication system)

Internet (i.e. Internet Queries)

Social media (i.e. Facebook, Twitter)

Other (please specify)

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* 7. Are you able to obtain an appointment with your primary care physician (family doctor) when you need one? If no, please explain why.

Yes

No (please explain)

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* 8. Do you receive all of your healthcare services locally?

Yes

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* 9. If you answered "No" to the previous question, for what services do you travel outside of your local area? (Select as many as apply to you)

Primary Care Physician (Family Doctor)

Specialty Care Doctor

Urgent Care Facility

Emergency Department

Other (please specify)

Question Title

* 10. If you have to travel out of your town for the service(s) identified in the previous question, why did you choose to leave town for this health service? If "Other", please specify in the comment box below. (Select as many as apply to you)

Physician referral

Insurance

Quality of Care/Lack of Confidence

Availability

Other (please specify)

Question Title

* 11. Have you, or someone in your household, delayed healthcare due to a lack of any of the following? (Select as many as apply to you)

Lack of Money

Lack of Insurance Coverage

I have health insurance coverage, but the insurance company did not approve of the request for healthcare

Other (please specify)

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* 12. List any other barrier(s) that delayed you from getting the care you needed?

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* 13. Is there one final comment that you would like to make about the health of the people in your community? For example, what one recommendation can you offer for improved health care services (i.e. programs, resources, policies)?

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* 14. Gender: How do you Identify?

Male

Female

Non-binary/ Gender Nonconforming

Rather Not Say

Self-describe:

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* 15. Which of the following describes your race/ethnicity? Multiple responses are allowed.

White

Black/African American

Hispanic or Latino

Native American

Asian

Pacific Islander

Other (please specify)

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* 16. What is the primary language spoken in your home?

English

Spanish

French

Portuguese

Arabic

American Sign Language

Vietnamese

Other (please specify)

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* 17. What is your age?

Under 18

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 to 84

85+

Public Social Services Plan Survey - Town of Athol

Town of Athol - Public Social Services Planning Survey

Question Title

* 1. Do you use a primary care (i.e. family) doctor for most of your routine health care?
(If Yes, skip to question #3)

Question Title

* 2. If you responded "No" in Question #1, then what kind of medical provider do you use for routine care?

Question Title

* 3. The following list includes amenities identified in your community as those that have some impact (positive or negative) on the health and well-being of the overall community. Please rank each based on how YOU BELIEVE they impact the health and well being of the overall community.

Question Title

* 4. In past surveys, community members identified common themes or issues such as those listed, below. How have these issues "changed" FOR YOU PERSONALLY over the past few years?

Question Title

* 5. If you need more information on a health topic, FROM WHOM do you obtain information?

Question Title

* 6. If you need more information on a health topic and obtain it from one or more sources identified in the previous question, HOW do you obtain the information? (Select as many as apply to you)

Question Title

* 7. Are you able to obtain an appointment with your primary care physician (family doctor) when you need one? If no, please explain why.

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* 8. Do you receive all of your healthcare services locally?

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* 9. If you answered "No" to the previous question, for what services do you travel outside of your local area? (Select as many as apply to you)

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* 10. If you have to travel out of your town for the service(s) identified in the previous question, why did you choose to leave town for this health service? If "Other", please specify in the comment box below. (Select as many as apply to you)

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* 11. Have you, or someone in your household, delayed healthcare due to a lack of any of the following? (Select as many as apply to you)

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* 12. List any other barrier(s) that delayed you from getting the care you needed?

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* 13. Is there one final comment that you would like to make about the health of the people in your community? For example, what one recommendation can you offer for improved health care services (i.e. programs, resources, policies)?

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* 14. Gender: How do you Identify?

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* 15. Which of the following describes your race/ethnicity? Multiple responses are allowed.

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* 16. What is the primary language spoken in your home?

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* 17. What is your age?

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* 18. What is the zip code of your residence?

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* 19. What is the Zip Code of your work place?

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* 1. Do you use a primary care (i.e. family) doctor for most of your routine health care?(If Yes, skip to question #3)

Question Title

* 2. If you responded "No" in Question #1, then what kind of medical provider do you use for routine care?

Question Title

* 3. The following list includes amenities identified in your community as those that have some impact (positive or negative) on the health and well-being of the overall community. Please rank each based on how YOU BELIEVE they impact the health and well being of the overall community.

Question Title

* 4. In past surveys, community members identified common themes or issues such as those listed, below. How have these issues "changed" FOR YOU PERSONALLY over the past few years?

Question Title

* 5. If you need more information on a health topic, FROM WHOM do you obtain information?

Question Title

* 6. If you need more information on a health topic and obtain it from one or more sources identified in the previous question, HOW do you obtain the information? (Select as many as apply to you)

Question Title

* 7. Are you able to obtain an appointment with your primary care physician (family doctor) when you need one? If no, please explain why.

Question Title

* 8. Do you receive all of your healthcare services locally?

Question Title

* 9. If you answered "No" to the previous question, for what services do you travel outside of your local area? (Select as many as apply to you)

Question Title

* 10. If you have to travel out of your town for the service(s) identified in the previous question, why did you choose to leave town for this health service? If "Other", please specify in the comment box below. (Select as many as apply to you)

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* 11. Have you, or someone in your household, delayed healthcare due to a lack of any of the following? (Select as many as apply to you)

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* 12. List any other barrier(s) that delayed you from getting the care you needed?

Question Title

* 13. Is there one final comment that you would like to make about the health of the people in your community? For example, what one recommendation can you offer for improved health care services (i.e. programs, resources, policies)?

Question Title

* 14. Gender: How do you Identify?

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* 15. Which of the following describes your race/ethnicity? Multiple responses are allowed.

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* 16. What is the primary language spoken in your home?

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* 17. What is your age?

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* 18. What is the zip code of your residence?

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* 19. What is the Zip Code of your work place?

* 1. Do you use a primary care (i.e. family) doctor for most of your routine health care?
(If Yes, skip to question #3)