Carlisle Tick-Borne Illness Survey 2012

Introduction

 
This survey is anonymous and is being conducted by the Carlisle Board of Health in collaboration with University of Massachusetts medical and nursing students. The information is intended to help reduce the incidence and severity of the town’s tick-borne diseases.

We thank you for your participation. The results will be shared with all town residents to improve our educational programs.
1. Year of birth?
2. Gender:
3. Highest degree obtained?

4. Principal in-town activities: (Check all that apply):
5. How many hours per week during the spring, summer and fall, on average, do you spend outdoors?
6. Of those hours, how many do you spend in wooded, grassy, tall brush areas (including at your own home)?
7. Number of times you have been treated for tick-borne disease, including Lyme disease, babesiosis, anaplasmosis, Rocky Mountain Spotted Fever:
8. Have any of your family members been treated for tick-borne disease, including Lyme disease, babesiosis, anaplasmosis, Rocky Mountain Spotted Fever:
9. Do you have pets that are allowed both indoors and outdoors?
10. Do you see deer on your property?