COMMUNITY NEEDS ASSESSMENT SURVEY

Purpose: This survey is designed to gather feedback about health needs and concerns in our community. Your responses will help us improve health services and programs.

Instructions: Please answer the following questions if you live in any of the following zip codes ( 92101, 92102, 92103, 92104, 92105, 92113, 92114, 92115, 92116, 92134, 92136, 92139, 92182) . Your responses are anonymous and confidential.
Age   *
Required
Gender:
 *
Required
Ethnicity
 *
Required
Primary Language Spoken
 *
Required
Household Income:
How many people live in your household?
Do you have health insurance?
Clear selection
if  you do not have health insurance, what is the reason?
Clear selection
Do you have a primary care provider?
Clear selection
Where do you primarily go for healthcare services
What are the top health concerns in your community? (Check all that apply)
How would you rate your overall health?
What barriers prevent you or others from accessing healthcare? (Check all that apply)
Do you feel there are enough mental health resources in your community?
Clear selection
What are the most common mental health challenges faced in your community? (Check all that apply)
What mental health resources would you like to see improved or expanded?
How would you rate access to healthy food in your community?
Do you feel there are enough opportunities for physical activity (e.g., gyms, parks, trails)?
Clear selection
What do you think prevents people from living a healthier lifestyle in your community? (Check all that apply)
Are educational opportunities in the community adequate?
Clear selection
What additional educational services are needed? (Open-ended)
Do you feel there are enough job opportunities in the community?
Clear selection
What are the biggest challenges to finding employment? (Check all that apply)
How safe do you feel in your community?
What environmental concerns are most pressing in your community? (Check all that apply)
Are you aware of any community health programs or services available to you
Clear selection
What types of health programs would be most beneficial? (Check all that apply)
What health topics would you like to learn more about?
Are you aware of the following resources in your community? (Check all that apply)
What additional resources or services would you like to see? (Open-ended)
Thank You!

Your input is valuable! For questions about this survey, please contact Antionette Simmons (arsimmons@mednet.ucla.edu)
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