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Thank you for taking the time to complete this survey. All responses are anonymous. Responses will be summarized and included in the final Community Needs Assessment. The survey should take approximately 10 minutes to complete.

* 1. What are the top 5 healthcare needs you see in your community? Please only select your top 5 choices.
* 2. Residents in the area are able to access a primary care provider when needed. (Family Doctor, Pediatrician, General Practitioner etc.)
* 3. Residents in the area are able to access a medical specialist when needed. (Cardiologist, Dermatologist, Neurologist etc.)
* 4. Residents in the area are able to access a dentist when needed.
* 5. There is a sufficient number of bilingual providers in the area.
* 6. There is a sufficient number of mental health providers in the area.
* 7. Transportation for medical appointments is available to area residents when needed.
* 8. What are the most significant barriers that keep people in the community from accessing health care when they need it? Please select your top 3 choices.
* 9. Are there specific populations in this community that you think are not adequately served?
10. If you answered YES to the previous question, please identify which populations you think are most underserved.
* 11. Related to health and quality of life, what resources or services do you think are missing in the community. Check all that apply.
* 12. What challenges do people in the community face in trying to maintain healthy lifestyles like exercising, eating healthy, managing chronic conditions.?
* 13. In your opinion, what is being done well in the community in terms of health and quality of life? Check all that apply.

Hospital Facility

* 14. Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital?
* 15. Using any number 0 to 10, with 0 being the worst and 10 the best, please rate the cleanliness and ambiance of the hospital.
* 16. Considering "on-site" hospital services what is the most important to you? Please choose all that apply.
* 17. What could be added to the hospital to improve your experience? Please check all that apply.
18. Would you recommend this hospital to your friends and family?
If you selected "No", please explain why:
19. Please share any other comments you have below:


* 20. Age
* 21. What is the highest level of school you have completed or the highest degree you have received?
* 22. What is your gender?
* 23. Which of the following categories best describes your employment status?
* 24. What is your zip code?
* 25. What is your race or ethnicity?
* 26. Which of the following ranges represents your total annual household income last year?
* 27. Do you work for the hospital or clinic? Again, the survey is is completely anonymous.