SBHC Community Leader Opinion Survey

School-Based Health Center Needs Assessment

Community Leader Opinion Survey
Dear Community Leader,

The Thomasville City School District is discussing the possibility of opening a School-Based Health Center to provide health services for students and their families, beginning with primary care health services. Students attending any school within the school district would be eligible to receive services at the School-Based Health Center. Services might include immunizations, physical exams, care of minor illnesses and related family support services. School-Based Health Centers provide health care to all students who have parental permission, regardless of insurance coverage or ability to pay (often at no cost or at low cost).

We are in the process of conducting a needs assessment to determine specific needs. To help us plan for the School-Based Health Center, we would like to ask you a few questions about what you see as the health needs of children and families in our community. Your answers are completely confidential, and you do not need to put your name anywhere on the survey.

Thank you for your help.
1. Affiliation (Check all that apply).

BusinessCitizen ActivistCity/County OfficialCivic OrganizationCommunity OutreachHealth ProfessionalLaw EnforcementFaith-Based OrganizationMedia/NewsNeighborhood AssociationSchool Board Member/Administrator/TeacherSocial Services ProviderNon-profit OrganizationOther
2. Member of Community:

< 3 years3 - 9 years10+ years
3. What do you think the main health problems are in our community?

a.   1st Answer
b.   2nd Answer
c.   3rd Answer
4. What do you think are the causes of these health problems?

a.   1st Answer
b.   2nd Answer
c.   3rd Answer
5. How can these health problems be reduced or eliminated in our community?
6. Which of these health problems do you consider to be the most important one in out community?
7. Can you suggest three other people with whom I might talk to about the health problems in our community?

Name: Name Affiliation: Affiliation Telephone: TelephoneName: Name Affiliation: Affiliation Telephone: TelephoneName: Name Affiliation: Affiliation Telephone: Telephone
8. Please consider sharing the link to the survey for others to complete (see below):

https://form.jotform.com/231025847155151
Should be Empty:

School-Based Health Center Needs Assessment