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* 1. How old are you?

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* 2. Sex?

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* 3. Do you live in the network's service area of Gogebic, Iron, or Vilas County?

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* 4. How long have you lived in Northern Wisconsin or Upper Michigan?

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* 5. What is your employment status?

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* 6. Are you a Veteran?

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* 7. Do you currently have a primary care provider?

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* 8. What city or community do you most often use for medical and dental care?

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* 9. Do you have health insurance?

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* 10. If Yes, do you receive:

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* 11. Do you have dental insurance?

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* 12. Have you had a physical or routine check-up in the 12 months?

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* 13. Have you received any dental care in the past 12 months?

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* 14. In the last 12 months have you postponed or avoided receiving medical or dental care because of cost concerns?

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* 15. Have you been screened for cancer, heart disease, or diabetes in the past 12 months?

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* 16. How would you rate your access to the following services?

Hospitals and Emergency Rooms?

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* 17. Outpatient Medical Clinics, including Urgent Care Centers?

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* 18. Behavioral Health Services, including Substance Abuse Treatment?

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* 19. Dental Care?

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* 20. Please rank from the list below your top five (5) rural health needs, with #1 being your most important concern and #5 being the lowest:

  1. Emergency medical services
  2. Chronic disease (cancer, stroke, diabetes, and heart disease)
  3. Drug abuse, including opioids, methamphetamine, and fentanyl
  4. Accessibility and availability of health and social services
  5. Health insurance coverage
  6. Dental care and dental providers
  7. Access and affordability of prescriptions
  8. Mental health and substance abuse services
  9. Patient and community education
  10. Training of health care and social service providers
  11. Cost of services and reimbursement by insurance providers
  12. Healthy lifestyles (obesity, nutrition, and physical activity)
  13. Recruiting additional health professionals