Community Health Survey Step 1 of 5 20% Please answer the following questions to the best of your ability. Remember, this survey is anonymous and voluntary. Your answers will not be linked to you.All responses are required. Please identify the most important health issues in our community. Choose all that apply: Health Issues(Required) Aging issues, such as Alzheimer's disease, hearing loss, memory loss or arthritis Cancer Chronic Pain Dental health (including tooth pain) Diabetes Heart disease/heart attack HIV/AIDS Infectious/contagious disease, such as flu, pneumonia, food poisoning Injuries and falls Lung disease (asthma, COPD) Mental health issues such as depression, hopelessness, anger, etc. Obesity/overweight Sexually transmitted infections Stroke Other, please explain: Unknown Please explain other health issues(Required) Please identify the most important unhealthy behaviors in our community. Choose all that apply: Unhealthy Behaviors(Required) Alcohol Abuse Child abuse Domestic violence Gun violence Drug Abuse Elder abuse (physical, emotional, financial, sexual) Lack of exercise Not able to get a routine checkup Poor eating habits Reckless driving Risky sexual behavior Smoking Other, please explain: Unknown Please explain other unhealthy behaviors(Required) When you get sick, where do you go?(Required) Clinic/doctor's office Urgent care Emergency Department (ER) I don't seek medical attention. Other Please explain where you go when you get sick(Required) How long has it been since you have been to the doctor to get a checkup when you were well (not because you were already sick)?(Required) Within the last year 1-2 years ago 3-5 years ago More than 5 years ago I have never been to a doctor for a checkup In the last year, was there a time when you needed medical care but were not able to get it?(Required) Yes No Why weren't you able to get medical care? Choose all that apply.(Required) I didn't have health insurance I couldn't afford to pay my co-pay or deductible I didn't have any way to get to the doctor The doctor or clinic refused to take my insurance or Medicaid I didn't know how to find a doctor Fear Too long to wait for appointment Other Please explain why you couldn't get medical care(Required) About how long has it been since you have been to the dentist to get a checkup (not for an emergency)?(Required) Within the last year 1-2 years ago 3-5 years ago More than 5 years ago I have never been to the dentist for a checkup In the last year, was there a time when you needed dental care but could not get it?(Required) Yes No Why weren't you able to get dental care? Choose all that apply.(Required) I didn't have dental insurance I couldn't afford to pay my co-pay or deductible I didn't have any way to get to the dentist The dentist refused to take my insurance or Medicaid I didn't know how to find a dentist Too long to wait for an appointment Fear Other, please explain: Please explain other reason you weren't able to get dental care.(Required) In the last year, was there a time you needed mental health counseling but could not get it?(Required) Yes No Why weren't you able to get mental health counseling? Choose all that apply.(Required) I didn't have insurance I couldn't afford to pay my co-pay or deductible I didn't have any way to get to a counselor The counselor refused to take my insurance or Medicaid I didn't know how to find a counselor Too long to wait for an appointment Fear Embarrassment Other, please explain: Please explain other reason you weren't able to get mental health counseling.(Required) In the last week, did you participate in deliberate exercise (such as, jogging, walking, golf, weight-lifting, fitness classes)?(Required) Yes No On a typical day, do you worry about not being able to provide food for you or your family?(Required) Yes No Do you smoke?(Required) No Cigarettes Vapes/E-Cigarettes Where do you get most of your medical information?(Required) Doctor/physician Friends/family Internet Pharmacy Other Please explain where you get medical information(Required) Do you have a primary care doctor?(Required) Yes No Overall, my physical health is:(Required) Good Average Poor Overall, my mental health is:(Required) Good Average Poor How long has it been since you have had a flu shot?(Required) Within the last year 1-2 years 3-5 years 5 or more years ago I have never had a flu shot What is your sex?(Required) Male Female Other Prefer not to say What is your age range?(Required) Under 20 21-30 31-40 41-50 51-60 61-70 71 or older What is your race?(Required) American Indian or Alaska Native Asian Black Native Hawaiian or Other Pacific Islander White Other Please enter your race(Required) What is your ethnicity?(Required) Hispanic Non-Hispanic What is your country of birth?(Required) What is your highest level of education?(Required) Less than high school Some high school High school degree (or GED/equivalent) Some college (no degree) Associate's degree Bachelor's degree Graduate or professional degree Other Please explain your level of education(Required) What is your job status?(Required) Full-time Part-time Unemployed Retired Disabled Student Military CAPTCHA