Community Health Needs Survey Demographics Question Title * 1. Age: 18-24 25-34 35-44 45-54 55-64 65 and older Question Title * 2. Sex: male female Question Title * 3. Ethnic group you most identify with: African American/Black Asian/Pacific Islander Hispanic/Latino Native American Caucasian/White Question Title * 4. Marital status: married/cohabiting not married/single Question Title * 5. Education: less than high school high school diploma or GED college degree or higher other Question Title * 6. Number of persons in household: 1 2 3 4 5 or more Question Title * 7. Household income: Less than $10,000 $10,000-$14,999 $15,000-$19,999 $20,000-$25,000 $25,000-$50,000 $50,000-$75,000 $75,000-$100,000 $100,000 or more Question Title * 8. How do you pay for your health care? (check all that apply) cash (no insurance) health insurance (e.g., private insurance) Medicaid Medicare Veterans' Administration other Next
