Thank you for participating in the University of Maryland Shore Regional Health Survey. All
information gathered in this survey will be anonymous and confidential. We want to
hear from you. The information gathered from this survey will be used to help
better understand the health issues and needs of our community. It will then be
used to create better services and community health programs. The survey should
take approximately 5-10 minutes to complete. After completing the survey, you will
be offered the opportunity to enter your name and email for a chance to win an
Amazon Gift Card. Two winners will be selected. Your name and email will NOT be
connected to your health survey answers. Thank you for taking the time to complete
the survey.

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* 1. What county do you live in?

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* 2. What is your zip code?

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* 3. What is your sex?

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* 4. Which one of these groups would you say best represents your race/ethnicity? (Select all that apply)

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* 5. What is your age?

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* 6. Where do you get your health information? Select all that apply.

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* 7. What are the three most important health problems that affect the health of your community? Please check only three

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* 8. What are the three most important social/environmental problems that affect the health of your community? Please check only three

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* 9. What are the three most important reasons why people in your community do not get health care? Please check only three

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* 10. Related to health, what resources or services do you think we need more of in the community?
Please check only three

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* 11. What ideas or suggestions do you have to improve health in your community?

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* 12. To be entered into the $100 Amazon Gift Card Raffle, please leave your contact information below (Optional)

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