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Community Health Survey 2012

Welcome to our Health Needs Survey.

Welcome to our Community Health Survey. Please take a minute to complete all questions as your opinion matters to us.

We utilize your feedback to improve our products and services.

Thank you,
Wilson County Health Department

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1.	Are you aware of health information being available on the Wilson County Health Department's website and via Facebook at www.wilson-co.com?

	Yes No

2.

Were the extended Health Department hours and availability of immunizations at alternate locations: (please check all that apply)

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	An incentive for myself/child to receive teen immunizations
	Convenient
	Did not meet myself or child's needs for obtaining immunizations
	Was not indicated for myself or my child
	Not aware of these opportunities for teen immunizations

3.	Do you have a doctor to see if you get hurt, sick or need a check up?

	Yes No

4.	Including yourself, how many people currently live in your house?

5.

What is your yearly household income?

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	$10,000-$20,000
	$20,000-$30,000
	$30,000-$40,000
	$40,000-$50,000
	$50,000-$60,000
	more than $60,000

6.

Is your heritage:

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	African American
	Asian
	Hispanic/Latino
	American Indian
	Middle Eastern
	White
	Other

7.	Do the hours of operation for the health department accommodate your needs? If you answer no, then what hours would better serve you?

	Yes No Additional Comments

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