Erie County Community Health Assessment Consumer Survey 2012 - 2013

Instructions: The Erie County Department of Health is currently working with community partners to solicit information from residents to help with public health planning for the next four years. We want to know what you think! Please take a few moments to fill out this survey, your responses will help us identify gaps in services and needs in the community. We can then use this information to create a plan to fill the gaps and address the needs going forward. Thank you for your time and help with this effort.
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A. Introduction

Please be honest, we guarantee that your identity will never be known or sought. Only take this survey once.




B. Your habits and your health

In this section we want to learn about the perceptions and behaviors associated with your individual health status.

















Most visited Least visited

Most visited Least visited

Most visited Least visited

Most visited Least visited

Most visited Least visited

Most visited Least visited

Most visited Least visited







C. Health needs in your community

In this section we are interested in knowing what you think are the most important issues related to health in your community.




D. Demographics

Tell us about yourself












E. Thank you very much!



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