Well Being Survey

Monroe County Well Being Survey

This survey is for people 18 and older who live and/or work in Monroe County. Information gathered in the survey will help identify community health priorities and assist in developing health-related programs and services. This survey will take approximately 10 minutes to complete.

Please note: questions with an asterisk (*) are required. Your answers are anonymous and confidential.

If you wish to stop taking the survey at any time, you may do so.
1.Do you live in Monroe County at least six months of the year?(Required.)
2.Where do you live?(Required.)
3.Do you work in Monroe County?(Required.)
4.What is your age?(Required.)
5.Sex assigned at birth:
6.How many jobs do you currently have?(Required.)
7.What is the highest grade or year of school you completed?
8.Which of the following would you say is your race? Check all that apply.(Required.)
9.Are you of Hispanic, Latino/a, or Spanish origin?(Required.)
10.What is the primary language you speak in your household?
11.For what type of business or organization do you work?
If you work more than one job, choose all options that apply.(Required.)
12.How strongly do you agree or disagree with the following statement: "I think Monroe County is a healthy place in which to live, work, or spend time."(Required.)
13.Would you say that in general, your overall health is:
14.Would you say that in general, your mental health is:
15.How often do you consume alcohol weekly?
16.Would you say you have never used e-cigarettes or other electronic vaping products in your entire life, or now use them every day, use them some days, or used them in the past but do not currently use them at all?
17.Do you now smoke cigarettes every day, some days, or not at all?
18.Choose 5 health concerns for you, your family, and your close social circle (friends, neighbors, coworkers, etc.)? 

Please select no more than 5.(Required.)
19.Please provide additional information about your responses above:
20.In your opinion, what are the TOP 5 social and economic issues that affect health in Monroe County? 

Please select no more than 5.(Required.)
21.Please provide additional information about your responses above.
22.In your opinion, what are the TOP 5 environmental health and safety issues in Monroe County? 

Please select no more than 5.(Required.)
23.Please provide additional information about your responses above:
24.Where do you or your family go when sick or in need of healthcare?
25.How do you pay for healthcare (non-dental)?
26.In the past 12 months, have you had any difficulty in obtaining any of the following?(Required.)
Medical
Dental
Mental Health
Prescription Medications
Yes
No
27.Please comment on any difficulties in obtaining medical, dental, mental health care or prescription medications.
28.In the 12 months, which of the following issues have made it difficult or prevented you from getting medical, dental, or mental health services for you or your family?

Please select all that apply.
29.How many times per week do you engage in physical activity/exercise?
30.What type of physical activity or exercise do you do the most weekly? (Check all that apply)
31.Are you limited in any activities because of any long-term health problem or disability, including physical health, emotional, or learning problems?
32.Please share any additional comments in the space provided below.
33.How did you learn about this survey?