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  Gynecology
 Mental Health/Behavioral Health  Vision
 Children’s Health Care  Tele-Derm
 Pregnancy Care  Tele-Psychiatry
 Chronic Disease Programs  

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* 1. What additional services would you like to have more available on Lana’i?

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* 2. Please pick the top three most important health issues in your community:

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* 3. Background Information - Male or Female?

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* 4. Background Information - What is your age?

Infant to 120
i We adjusted the number you entered based on the slider’s scale.

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* 5. Background Information - What is the highest level of education you have completed? Please choose ONE.

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* 6. Which of the following categories best describes your gross household income during the last year?

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* 7. How many people live in your home, including yourself?

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* 8. Which ethnicity do you identify most with?

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* 9. Health Problems you currently have: (Please list)

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