COMMUNITY HEALTH NEEDS ASSESSMENT 2025 Question Title * 1. What is your zip code? 63552 63549 63539 63538 63537 63534 63532 63530 63558 63557 63431 65263 65247 Other area Question Title * 2. What is your gender? Female Male Question Title * 3. Which ethnicity best describes you? (Please choose only one.) American Indian or Alaskan Native Asian Native Hawaiian/Pacific Islander Black or African American Hispanic White / Caucasian Other (please specify) Question Title * 4. Including you, how many in your household are... Number Over 18 0 1 2 3 4 5 6 7 8 9 10 Over 18 Number menu Under 18 0 1 2 3 4 5 6 7 8 9 10 Under 18 Number menu Question Title * 5. How long have you lived in the area? Less than a year 1-5 Years 6-15 Years 15+ Years Question Title * 6. How would you describe your housing situation? Own house or condo Rent house, apartment or room Living in a group home Living temporarily with a friend or relative Multiple households sharing an apartment or house Living in a shelter Living in a motel Living in senior housing or assisted living Other (explain) Question Title * 7. Counting all income sources from everyone in your household, what was the combined household income last year? (Optional) Less than $20,000 $20,000-$49,999 $50,000-$69,999 $70,000-$99,999 $100,000 or more Question Title * 8. What is your highest level of education? Less than high school degree High School Diploma GED Currently Attending College Associate College Degree Bachelor College Degree Graduate Level Degree Question Title * 9. Some of the following issues may have been a problem in your household. If any have been a problem in the last 12 months please tell us how much of a problem. How much of a problem Adult Substance Abuse (alcohol or legal medication) Not a problem Minor problem Major problem Don't know Adult Substance Abuse (alcohol or legal medication) How much of a problem menu Adult Substance Abuse (illegal drugs) Not a problem Minor problem Major problem Don't know Adult Substance Abuse (illegal drugs) How much of a problem menu Youth Substance Abuse (alcohol, drugs, etc) Not a problem Minor problem Major problem Don't know Youth Substance Abuse (alcohol, drugs, etc) How much of a problem menu Caring for Adult with disabilities Not a problem Minor problem Major problem Don't know Caring for Adult with disabilities How much of a problem menu Caring for a Child with disabilities Not a problem Minor problem Major problem Don't know Caring for a Child with disabilities How much of a problem menu Child Abuse Not a problem Minor problem Major problem Don't know Child Abuse How much of a problem menu Physical Violence against adults Not a problem Minor problem Major problem Don't know Physical Violence against adults How much of a problem menu Mental Health Concerns Not a problem Minor problem Major problem Don't know Mental Health Concerns How much of a problem menu Not having enough money for food Not a problem Minor problem Major problem Don't know Not having enough money for food How much of a problem menu Not able to afford nutritious food (fresh fruit and vegetables) Not a problem Minor problem Major problem Don't know Not able to afford nutritious food (fresh fruit and vegetables) How much of a problem menu Not able to be Physically active Not a problem Minor problem Major problem Don't know Not able to be Physically active How much of a problem menu Not able to afford transportation Not a problem Minor problem Major problem Don't know Not able to afford transportation How much of a problem menu Not having enough money for housing Not a problem Minor problem Major problem Don't know Not having enough money for housing How much of a problem menu Not having enough money to pay doctor, dentist or pharmacy Not a problem Minor problem Major problem Don't know Not having enough money to pay doctor, dentist or pharmacy How much of a problem menu Not having enough money to pay for mental health counselor Not a problem Minor problem Major problem Don't know Not having enough money to pay for mental health counselor How much of a problem menu Getting annual Immunizations Not a problem Minor problem Major problem Don't know Getting annual Immunizations How much of a problem menu Use of tobacco/vaping products Not a problem Minor problem Major problem Don't know Use of tobacco/vaping products How much of a problem menu Not being able to find or afford after school care Not a problem Minor problem Major problem Don't know Not being able to find or afford after school care How much of a problem menu Sexual abuse Not a problem Minor problem Major problem Don't know Sexual abuse How much of a problem menu Suicide Not a problem Minor problem Major problem Don't know Suicide How much of a problem menu Teen Pregnancy Not a problem Minor problem Major problem Don't know Teen Pregnancy How much of a problem menu Other (explain) Question Title * 10. What is the biggest challenge you face as an Individual? Question Title * 11. What is the biggest challenge you face as a Family? Question Title * 12. What issues most concern you regarding young persons (under 18) in your household? Question Title * 13. Has everyone in your family (those living in your household) seen a healthcare professional at least once in the last 12 months? Yes, everyone has No, but some have No, no one has Question Title * 14. If the last visit for a household member was more than 12 months ago, please check why. Check all that apply. Do not have a medical condition requiring care/ I only seek health care when I need to Do not receive any routine health screenings. Could not schedule appointment due to work or personal conflicts with normal business hours Could not afford payments due, regardless of insurance status Could not arrange transport Question Title * 15. If you or a household member used a hospital emergency room in the past 12 months, was it due to: Acute Illness Injury requiring immediate attention Injury not requiring immediate attention but most convenient/only service available Ongoing Illness Dental Care No one in my household used hospital emergency room in the last 12 months. Question Title * 16. How many times in the last 12 months have you or any household member used an Urgent Care, Rural Health Clinic or Federally Qualified Health Clinic - Check all that apply None 1-2 Times 3-5 Times 6 or more Times Total Family Health Care Macon Medical Clinic - Dr. Deline Macon Family Health Urgent Care Bevier Family Medical Question Title * 17. Do you access your health records through an online patient portal? Yes No Question Title * 18. What do you think are the most pressing health problems in your community? Ability to pay for care Affordable insurance Alcohol Alzheimers Drug abuse - prescription medications Drug abuse - illegal substances Cancer Child abuse COVID-19 Cost of health care Domestic violence Hunger/Malnutrition Lack of health insurance Lack of transportation to health care services Lack of dental care Lack of prenatal care Mental health Multiple Sclerosis Obesity in adults Obesity in children and teens Prescription medication costs Suicide Teen pregnancy Tobacco use/smoking among adults Tobacco use/smoking among teens Vaping among adults Vaping Among Teens Other (please specify) Question Title * 19. What medical services are most needed in your community? ( Check all that apply) Adult Daycare Adult Primary Care Services Cancer Treatment Counseling/Mental Health Services Diabetes Emergency/Trauma Care Heart Care Services ( Cardiology) Immunizations Orthopedic Care ( Bone and Joint) Children's Specialist Services (Pediatrics) Telemedicine Women's Health Services (Obstetrics/Gynecological) Other (please specify) Question Title * 20. What types of health education services are most needed in your community? (Check all that apply) Alcohol Abuse Alzheimer's Disease Asthma Breast Feeding Cancer Screening Child Abuse/Family Violence Diabetes Diet and/or Exercise Drug Abuse HIV/AIDS Sexually Transmitted Diseases Smoking Cessation and/or Prevention Stress Management Other (please specify) Question Title * 21. What health or community services should be provided that are currently not available? Question Title * 22. What ideas or suggestions do you have for improving the overall health of the community? Question Title * 23. To be included in a drawing for one of five $100 gift cards, please complete the following information: Name Email Address Phone Number Done
