Orchard Hospital Survey - Community Health Needs

Please take a moment to complete the survey below. The purpose of this survey is to seek your input regarding community health problems in south Butte County. Orchard Hospital will use the results of this survey to identify and take action of community needs.

Orchard Hospital Survey - Community Health Needs

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* 1. Where do you go for routine healthcare?

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* 2. Are there issues that prevent you from accessing healthcare?

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* 3. In the following list, what do you think are the three most important factors for a "Healthy Community?" (check only three)

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* 4. In the following list, what do you think are the three most important "health problems" in our community? (Those problems which have the greatest impact on overall community health.)

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* 5. In the following list, what do you think are the three most important "risky behaviors" in our community? (Those behaviors which have the greatest impact on overall community health.)

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* 6. How would you rate our community as a "Healthy Community?"

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* 7. How would you rate your own personal health?

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* 8. Approximately how many hours per month do you volunteer your time to community service?

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* 9. What is the zip code where you live?

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* 10. How old are you?

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* 11. What is your gender?

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* 12. What ethnic group do you most identify with?

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* 13. What is your marital status?

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* 14. What is your highest level of completed education?

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* 15. What is your annual household income?

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* 16. How do you pay for your healthcare? Check all that apply

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* 17. Where/how did you get this survey? Check one