Fulton County Medical Center and its community partner Fulton County Family Partnership is gathering information as part of a plan to improve health and quality of life in the community it serves.  Community input is essential to this process.  This survey is being used to engage community members.  

Some of the following survey questions are open-ended.  In these instances, we are trying to gather your thoughts and opinions.  There are no right or wrong answers.  The themes that emerge from these questions will be summarized and made available to the public; however, your identity will be kept strictly confidential.

It will take approximately fifteen minutes to complete the questionnaire.  Your participation in this study is completely voluntary.  There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point.  It is very important for us to learn your opinions. 

If you have questions at any time about the survey or the procedures, you may contact Aaron Hershberger at (513) 562-5560 or by email at ahershberger@bkd.com.

Thank you very much for your time and support.

How would you rate your (personal) overall health?
Overall, how would you rate the health status of your community?
In general, how satisfied are you with your quality of life?
What would improve the quality of life within your community? Please check all that apply.
Do you have one person you consider your personal care doctor or primary care provider?
Have you had a visit with your personal care doctor or primary care provider within the past year?
Have you had a dental visit within the past year?
Stress means a situation in which a person feels tense, restless, nervous, or anxious, or is unable to sleep at night because his/her mind is troubled. Within the last 30 days, how often have you felt any kind of stress?
Looking at the following items think about what causes stress in your daily life. Stress could be caused from not having the following, or being able to find them, or not having the preferred quality. Please check all that apply.
Was there a time in the past 12 months when you experienced any of the following?
As a child (during the first 18 years of life) did you experience any of the following?
Are you personally, or is anyone in your family currently experiencing any of the following? Please check all that apply.
How safe from crime do you consider the following?
How much of a problem are the following related to housing in your community?
Not a Problem1Somewhat of a ProblemBig Problem
Landlords not maintaining properties resulting in poor living conditions
Run down or abandoned properties
Individuals moving in with a relative because of cost of housing
Several families living in one house
People “couch surfing”, spending a few nights at several people’s homes but do not have their own home
Please rate your level of confidence in the following emergency services:
Not at all ConfidentSomewhat ConfidenttExtremely Confident
An ambulance would respond quickly to my home if I needed it
The fire department would respond quickly to my home if I needed it
The police department would respond quickly to my home if I needed it
Please rate your level of agreement with the following statements:
Please rate your level of agreement with the following statements:
NARCAN (naloxone) is a prescription medication used for the treatment of an opioid emergency such as an overdose or possible overdose. Have you or do you know anyone who has done the following?:
Do you currently use e-cigarettes or vaping pens?
Do you currently use chewing tobacco, snuff, or snus? (Note: snus [Swedish for snuff] is a moist smokeless tobacco, usually sold in small pouches that are placed under the lip against the gum)
Do you currently smoke cigarettes?
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