Idaho Public Health District 1 & 2

Please take a minute to complete the survey below. The purpose of this survey is to get your opinions about community health problems in your county. We will use the results of this survey and other information to identify the most pressing problems which can be addressed through hospital/public health/community action. Thank you.

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* 1. What county do you live in?

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* 2. What do you think are the three (3) most important factors for a "Healthy Community"? (Those factors which most improve the quality of life in a community.) Limited to three (3) choices.

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* 3. What do you think are the three (3) most important "risky behaviors" in our community? (Those behaviors which have the greatest impact on overall community health.) Limited to three (3) choices.

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* 4. What do you think are the three (3) most important "health problems" in our community? (Those problems which have the greatest impact on overall community health.) Limited to three (3) choices.

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* 5. Which hospital is in your area?

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* 6. Age:

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* 7. Sex:

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* 8. How do you pay for your health care? (Check all that apply)

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* 9. Where / how did you obtain this survey? (Check only one)

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