Dear Community Member:

Ely-Bloomenson Community Hospital (EBCH) is partnering with Rural Health Innovations, LLC a subsidiary of the National Rural Health Resource Center, to lead a community health survey.

Why are we asking you to complete the survey? You are part of the community and can have your voice heard as we plan for ways to improve health. We are looking for input from a wide range of people about health needs, programs and services. The results of the survey and other information will be used to prioritize ways to improve the health of our community.

Survey participation is voluntary. To complete the survey, you must be at least 18 years of age and live in the area served by EBCH.

The survey should take no more than 10 minutes to complete. Your survey answers will be recorded when you press the “Done” button at the end of the survey. If you leave the survey without pressing the “Done” button, your answers will not be saved.

Responses to this survey are confidential and anonymous. We will not record your name or other information that could be used to identify you. Summary results from all survey responses will be published in a report shared with the hospital. Your confidentiality will be maintained to the degree permitted by the technology used. Specifically, no guarantees can be made regarding the interception of data sent via the Internet by any third parties.

If you need assistance completing the survey, please contact Rural Health Innovations at copo@ruralcenter.org or (248) 884-1029.

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* 1. How would you rate the general health of our community? (Select only ONE response)

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* 2. What are the THREE most pressing health concerns in our community? (Select up to 3 responses)

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* 3. Select the THREE items below that you believe are most important for a healthy community? (Select up to 3 responses)

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* 4. What community resources do you rely upon to help keep you and your family healthy? (Select all that apply)

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* 5. In your opinion, what are the top THREE priorities to improve our community’s access to healthcare? (Select up to 3 responses)

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* 6. What are the THREE largest gaps in healthcare services in our community? (Select up to 3 responses)

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* 7. What can be done to improve the health of the community? (Select up to 3 responses)

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* 8. What is the greatest health education need in our community? (Select only ONE response)

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