How would you describe your overall health?
Where do you go for routine healthcare?
If you marked "other" in question 2, please list where you go for routine healthcare.
Are you able to visit a doctor when needed?
If you answered "No" to question 4, please choose all that apply.
If you marked "other" in question 5, please list why you are not able to visit a doctor when needed.
What type of healthcare coverage do you have?
If you marked "other" in question 7, please list what type of healthcare coverage you have.
Please select the top 3 health challenges you face.
If you marked "other" in question 9, please list health challenges you face.
What additional health services need to be offered to meet health challenges in your community?
Please choose all statements below that apply to you.
Which of the following preventive procedures have you had in the past 12 months?
What is your gender?
What is your county of residence?
If you marked "other" in question 15, please list what county you reside in.
What is your 5 digit zip code (Example 42701)?
What is your age?
What is your race?
What is your current employment status?
What is your household income range?
What is the highest level of education you have completed?
What can Hardin Memorial Health do to better meet the health needs of our community?