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Community Health Assessment Survey

Gathers data on community health needs, behaviors, and access to care across a defined population. Informs public health programming and resource allocation decisions.

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Community Health Assessment Survey

Help us understand the health needs and priorities in your community by completing this survey.

What is your age group?*

Do you currently have health insurance?*

YesNoNot sure

Which of the following health issues are concerns in your community?*

DiabetesHeart diseaseMental healthSubstance useObesityAccess to care

How would you rate access to healthcare services in your area?*

What is the biggest barrier to accessing healthcare for you or your family?

What health programs or services would you like to see in your community?

Template Details

CategoryHealthcare

IndustryHealthcare

Fields6

Uses0

Views1

healthcarecommunity healthpublic healthneeds assessmentsurvey

Community Health Assessment Survey - Free Healthcare Template | ZenBuild | ZenBuild