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Community Needs Assessment-Your Feedback

What town do you live in?

What is the top health care concern in your community?

What possible solutions can you identify to the health care concern listed above?

What do you consider the top problem facing your community?

What possible solutions can you identify to the problem you listed above?

Please select the category that best suits you.

Please tell us your gender.

Do you have health insurance?

Where do you get your hospital care?

Please offer any additional comments.

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25 Ridgewood Road I PO Box 2003 I Springfield, VT 05156 802-885-2151

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