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Your identity will remain anonymous. Your answers will help Magee General Hospital know how to best meet the needs of its community. 

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* 1. Have you had a routine physical exam in the past two years?

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* 2. Which of the following preventative procedures have you had in the past 12 months?

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* 3. What health challenges does your immediate family face? Select up to five choices.

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* 4. What health issues are in the community that need to be addressed?

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* 5. What is needed to improve the health of your family and neighbors? Check all that apply.

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* 6. Are there any issues that prevent you from accessing care?

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* 7. Select the most accurate statement regarding your health insurance.

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* 8. Please select the location(s) where you prefer to go to receive care.

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* 9. What additional health services need to be offered to meet health challenges in our community?

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* 10. What is your gender?

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* 11. Your zip code:

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* 12. Your age:

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* 13. What is your racial/ethnic identification?

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