Community Health Needs Assessment Survey
Please take a few moments to complete the survey below. The purpose of this survey is to obtain opinions about the state of your communities’ health. Loup Basin Public Health Department (LBPHD) along with other community partners will use the results to identify the most pressing community health issues which can be addressed through community action. Thank you for your time and please contact us with any questions.
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Your answer
Please enter the zip code where you live:
Your answer
Please indicate your age:
Select your gender:
Please identify the ethnic group you identify with:
How long have you lived in this community?
Are you satisfied with the quality of life in your community?
Is your community a good place to raise a family?
In the following list, please select the three most important factors for a healthy community.
Only select the top 3.
Are you satisfied with the health care system in the community?
Please list the facility you use most for your health care needs:
Your answer
Is your community a good place to grow old?
Is there economic opportunity in the community?
Is the community a safe place to live?
In the following list, select the top 3 health problems that are the most concerning in your community.
Only select the top 3.
In the following list, please select the top 3 risky behaviors that are most concerning in your community.
Only select the top 3.
How would you rate your community as a healthy community?
How would you rate your own personal health?
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