2022 Community Health Needs Assessment Survey 
The 2022 Community Health Needs Assessment Survey is both anonymous and voluntary. This survey is conducted by both the Putnam County Hospital and Putnam County Health Department and serves
 as an evaluation of the health needs of our community every three years. This survey may lead to the improvement of community health in Putnam County. Thank you so much for your participation and dedication to your community!  
Sign in to Google to save your progress. Learn more
What age range do you fall under?
*
What gender do you identify with? *
What is your race?
*
What is your highest level of education?
*
What was your total household income last year, before taxes?
*
Martial Status?  *
Do you rent or own the household where you live?
*
How many people live in your household? *
What is your job status?
*
What would you say your general health is?  *
What would you say your mental health is? *
About how long has it been since you visited a doctor for a routine check-up?  *
Have you seen a primary physician in the last 12 months?  *

What is the primary source of your healthcare coverage?

*
How often do you exercise or get physical activity (30 minutes or more of activity)?   *
What would you consider your eating habits?  *

Do you believe that Putnam County restaurant and grocery stores offer selections sufficient enough for a healthy diet?

*
Insufficient
Sufficient
How often do you eat fast food?  *

How often do you smoke cigarettes?

*
How often do you vape? *
Have you taken action in the last 12 months to quit smoking? *
Do you use other tobacco products (chewing tobacco)?  *
How often do you use chewing tobacco?  *

How often do you drink alcoholic beverages?

*
In the past 30 days have you had 5 or more drinks in one sitting?  *
Have you used drugs other than those required for medical reasons?
*

Have you gone to anyone for help for a drug problem? 

*

If you are a female 45 years and older have you had a mammogram in the last 2 years?

*
If you are a female have you had a pap smear in the last 3 years? *

If you are 45 years or older have you had a Colonoscopy/ Sigmoidoscopy?

*

Has a doctor ever told you that you have high blood pressure?

*

Has a doctor ever told you that you have high cholesterol?

*

Has a doctor ever told you that you are overweight?

*
Please identify the three most important health issues in our community (select three options below)  *
Required

What do you think needs to be improved upon in the community to improve the overall health of Putnam County? (Select three options below) 

*
Required
Would access to telemedicine increase the chance that you would seek medical care? *
Please identify the three (3) most important factors that negatively impact your well-being in our community (select three options below) 
*
Required
When you get sick, where do you go? 
*
In the last year, was there a time when you needed medical care but were not able to get it?
*
If you answered "yes" to the previous question, why weren't you able to get medical care? Choose all that apply. 
Where do you get most of your medical information?
*
What type of transportation do you use to seek medical services?  *
How accessible is obtaining a COVID-19 test for you?  *
Easy
Difficult
How accessible is receiving a COVID-19 vaccination for you?
Easy
Difficult
Clear selection
How satisfied are you with Putnam County school systems or education?  *
Not satisfied
Satisfied
How safe do you feel living in Putnam County?  *
Not safe
Safe

What are the things that make it difficult for you to find and/or keep work? (check all that apply)

*
Required

What do you think needs to be in the community that would improve your health?

Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy