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Lana’i Community Health Center Community Needs Assessment Survey - English

Community Needs Assessment Survey- English

This survey is being conducted by the Lana’i Community Health Center (LCHC) to ensure that we are doing our best to meet the needs of the Lana’i community. We appreciate your help in answering these survey questions and ask that you be as honest as possible as your answers will be anonymous.  Please DO NOT put your name on this survey. Thank you.

LCHC provides integrated services including the following:
Dental Care Health Education
Medical Care for Elderly Tele-OB/Gynecology
Mental Health/Behavioral Health Vision
Children’s Health Care Tele-Derm
Pregnancy Care Tele-Psychiatry
Chronic Disease Programs OB Ultrasound
Tele-GI Tele-Nephrology
Tele-Pediatrics Tele-Cardiology
Abdominal Ultrasound, Renal Bladder, Liver, Pelvic, Thyroid, Vascular, Breast, Subcutaneous Masses  
Outreach Eligibility Assistance
1.What additional services would you like to have more available on Lana’i?(Required.)
2.Please pick the top three most important health issues in your community:(Required.)
3.Please pick the top three most important social issues in our community:
4.Please identify any barriers that you believe make your access to health care services difficult:(Required.)
5.Are you aware that LCHC has financial assistance (i.e., sliding fee scale, budget plans, etc.) available for patients who might be reluctant to seek health care services because of financial limitations?
6.Background Information - Male or Female?
(Required.)
7.Background Information - What is your age?
Infant
to
120
8.Background Information - What is the highest level of education you have completed? Please choose ONE.(Required.)
9.Which of the following categories best describes your gross household income during the last year?(Required.)
10.How many people live in your home, including yourself?

(Required.)
11.Which ethnicity do you identify most with?
12.Which ethnicity do you identify most with?(Required.)
13.Health Problems you currently have: (Please list)
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