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Please answer these questions for where you live.

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* Where do you see positive progress in your community over the last three years? (Pick as many as you want)

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* What are the biggest health needs in your community? (Pick the 3 you think are most important)

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* What social needs cause health problems in your community? (Pick the 3 root causes you think are most impactful)

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* Have you or someone in your family experienced violence or seen violence in your community? (Examples of violence could be things like domestic /intimate partner violence, sexual violence, community assaults or gun violence)

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* Have you or your family experienced discrimination or bias while receiving healthcare? (Examples of discrimination could be things like racism or sexism or ageism)

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