Osceola County Community Health Needs Assessment

Household information

Osceola Regional Health Center and Osceola Community Health Services (Public Health) are conducting a Community Health Needs Assessment (CHNA) in order to better understand the health concerns of our community. We would appreciate you completing this anonymous survey so we can learn from your experiences and opinions. Thank you for sharing with us!

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This section is to collect general information about you and your household.

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* 1. What is your 5-digit zipcode?

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* 2. What is your gender?

Male

Female

Other (please specify)

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* 3. How old are you?

Under 18

18-24

25-34

35-44

45-54

55-64

65-74

75+

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* 4. What is the annual income of your household?

Less than $25,000

$25,000-$50,000

$50,000-$75,000

$75,000-$100,000

Over $100,000

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* 5. What type of health insurance coverage do you have? Select all that apply.

No health insurance

Private health insurance

Insurance through employer (through your job or the job of a family member)

Government program (Medicare, Medicaid, Iowa Health and Wellness Plan, etc.)

Aetna/Humana Medicare replacement coverage

Other (please specify)

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* 6. What is your race/ethnicity? Select all that apply.

African American

American Indian or Alaska Native

Asian

Caucasian

Hispanic

I prefer not to answer

Other (please specify)

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* 7. What is your employment status?

Unemployed

Work Part-time

Work Full-time

Retired

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* 8. How many people live in your household? Include people of all ages.

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* 9. What is the highest level of education you have received?

Completed some high school

High school graduate or GED

Completed some college

Associate degree

Bachelor's degree

Completed some postgraduate

Master's degree

Ph.D., law or medical degree

Other advanced degree beyond a Master's degree