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Brown County Community Health Survey

Please take a minute to complete the survey below. The purpose of this survey is to get your opinions about community health problems in Brown County. The Brown County Health Department will use the results of this survey and other information to identify the most pressing problems which can be addressed through community action.  Remember... your opinion is important! Thank you!

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* 1. In the following list, what do you think are the three most important factors for a "Healthy Community?" (Those factors which most improve the quality of life in a community.)

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* 2. In the following list, what do you think are the three most important "health problems" in our community? (Those problems which have the greatest impact on overall community health.)

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* 3. In the following list, what do you think are the three most important "risky behaviors" in our community? (Those behaviors which have the greatest impact on overall community health.)

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* 4. How would you rate our community as a "Healthy Community?"

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* 5. How would you rate your own personal health?

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* 6. Approximately how many hours per month do you volunteer your time to community service? (e.g., schools, voluntary organizations, churches, hospitals, etc.)

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* 7. Please answer questions #7-15 so we can see how different types of people feel about local health issues.

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* 8. Age:

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* 9. Sex:

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* 10. Ethnic group you most identify with:

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* 11. Marital Status:

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* 12. Education:

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* 13. Household Income:

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

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* 15. Where did you hear about this survey?

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* 16. I would like more information about this community project (optional):

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