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Community Needs Assessment Survey
Para ver la información en español, seleccione la opción en el menú desplegable ubicado en la esquina superior derecha.
1.
What is your ZIP Code?
75001
75006
75019
75038
75039
75040
75041
75042
75043
75044
75048
75050
75051
75052
75060
75061
75062
75063
75080
75081
75088
75089
75104
75115
75116
75134
75137
75141
75146
75149
75150
75159
75172
75180
75181
75182
75201
75202
75203
75204
75205
75206
75207
75208
75209
75210
75211
75212
75214
75215
75216
75217
75218
75219
75220
75223
75224
75225
75226
75227
75228
75229
75230
75231
75232
75233
75234
75235
75236
75237
75238
75240
75241
75243
75244
75246
75247
75248
75249
75251
75253
75254
75270
75390
2.
What race or ethnicity do you consider yourself?
African American/Black
American Indian or Alaska Native
Asian
Hispanic or Latino
Multiracial/Mixed
White
None of the above
I prefer not to answer
3.
What is your gender?
Female
Male
I prefer not to answer
4.
What is the age of the person receiving services?
0-11 years
12-17 years
18-21 years
22-64 years
65+ years
5.
Do you experience challenges or barriers in any of the following areas? (Please check all that apply.)
Housing
Transportation
Food
Clothing
Employment
Income
Education
Language (i.e., translation services)
Childcare
Internet Access
Other (please list)
6.
What health-related services do you need that are difficult to access? (Please check all that apply.)
Therapy
Medical: Primary Care
Medical: Specialty Care
Dental
Vision
Drug and/or Alcohol Treatment
Social Security and/or Medicaid assistance
Health Literacy (i.e., assistance with reading/understanding health documents)
Case Management (i.e., someone to help me get supports or services)
Obtaining Medication
Intellectual and Developmental Disability Services
Veteran Services
Other (please list)
7.
How did you find out about Metrocare Services? (Please check all that apply.)
Friend/Family Member
Hospital/Residential Treatment
Primary Care Physician (PCP)
Advertisement (e.g., Dallas Examiner)
Religious Organization / Community Center
Criminal Justice System
Government Agency (e.g., Social Security Admin., Child Protective Services, Courts, etc.)
Social media (e.g., Facebook, Instagram, etc.)
School
Other (please list)
8.
How do you usually get to Metrocare?
I walk to my appointments
I drive to my appointments
My family and/or friends provide transportation to my appointments
I utilize public transportation (e.g., DART, Medicaid ride, etc.) to get to my appointments
Community Agency (e.g., Transicare, Adult Community Housing, etc.)
I don't have a consistent way to get to Metrocare
Other (please list)
9.
How long does it generally take you to get to the Metrocare clinic?
Less than 30 minutes
30 minutes to 1 hour
1 to 2 hours
More than 2 hours
10.
Do you or someone you know need access to the following services? (Please check all that apply.)
Substance Use Disorder or Medication Assistance Treatment Services
Pregnancy and/or Postpartum Support Services
Care Coordination
Primary Care
Crisis Services
Onsite presence at other agencies (e.g., food pantries, community centers, etc.)
Respite Services (care for children for breaks for the caregiver)
Family Counseling
Virtual Appointments
