Wayne Memorial Hospital and leadership throughout the northeastern corner of Pennsylvania need your help.

We are conducting a study on health care needs which will guide the development of new or expanded programs in the area.

Please take a few minutes to complete the following survey. Please Note: Because of the intentionally broad distribution of this survey, you may receive more than one request to complete it. We apologize for this inconvenience and ask that you disregard any additional requests to complete the survey.

All responses are confidential, and you may choose not to answer any questions that you would prefer not to for any reason. If you have any questions, contact Jack Dennis at Wayne Memorial Hospital at (570) 251-6533.

Thanks so much!

* 1. What is your age?

* 2. Are you male or female?

* 3. Are you employed in the health care, prevention, behavioral health, dental care or human services areas? If so, please check those that apply: