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Survey Instructions

Washington County Public Health invites you to participate in this survey to determine the greatest health needs in our community. The information gathered from this survey will be used to develop an action plan to improve the health of Washington County.

All responses are anonymous and will be collected and sent directly to Public Health for data entry. You can skip any question you do not want to answer. If you receive more than one invitation to complete the survey, please fill it out only once. The survey will take about 15 minutes to complete.

Remember, your opinion is important and will help our community. Thank you for your time!

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* 1. What do you think are the five (5) most important factors for a healthy community and a good quality of life?

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* 2. What do you think are the top five (5) health concerns in our community

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* 3. What do you think are the top five (5) barriers to health and well-being in our community?

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* 4. Thinking of you and your family, which barriers keep you from being healthy?

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* 5. What are five (5) things that our community does well?

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* 6. What are five (5) things that our community could improve?

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* 7. Thinking about you and your family, what is missing or most needed in our community to improve your health? Please choose all that apply.

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* 8. In the past 12 months have you ever worried whether you would run out of food before getting the money to buy more?

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* 9. Within the past 12 months the food we bough just didn't last and we didn't have money to get more.

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* 10. Based on your experiences in the pats 12 months, how easy or difficult is it for you to access the following services?

  Very easy Easy Average Difficult Very Difficult N/A
Primary Care Doctor
Dentist
Mental health provider
Specialty doctor
Emergency care
Public Health/Immunization services
Family or parent support services
Child care services
Social services/ community assistance

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* 11. If it was "difficult" or "very difficult" to receive services, what made it difficult? Please choose all that apply.

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* 12. In the past year, how many times have you used Washington County Health Center's ER?

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* 13. In what zip code do you live?

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* 14. Do you rent or own the place where you live?

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* 15. What is your age?

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* 16. What is your gender?

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* 17. Which race/ethnicity best describes you? Choose all that apply.

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* 18. What is the highest level of education that you have completed?

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* 19. What is your total household income?

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* 20. How many people currently live in your household (including yourself)

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* 21. Any additional comments?

Thank your for taking the time to complete the survey!
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