Community Health Needs Survey 2014

Question Title

* 1. What is your ethnic origin? (Check one)

White

American Indian

Hispanic

Asian/Pacfic Island

Black

Other (please specify)

Question Title

* 2. What is your gender?

Female

Male

Question Title

* 3. What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older