CRRC Community Survey Spam protection, skip this field Question 1: In our community, how much need is there for: Primary Health Care Providers: (optional) High Need Low Need No Need Don't Know Pediatric (Children) Physicians: (optional) High Need Low Need No Need Don't Know Alternative Medical Treatment: (optional) High Need Low Need No Need Don't Know Community Support Groups: (optional) High Need Low Need No Need Don't Know Access to Specialist Care: (optional) High Need Low Need No Need Don't Know Access to Long-Term Care: (optional) High Need Low Need No Need Don't Know Transportation for Health Care Services: (optional) High Need Low Need No Need Don't Know Social/Recreation Opportunities for Seniors: (optional) High Need Low Need No Need Don't Know Increased Availability to Childcare: (optional) High Need Low Need No Need Don't Know Home Visits for Newborns: (optional) High Need Low Need No Need Don't Know Parenting Education: (optional) High Need Low Need No Need Don't Know Geriatric Physicians: (optional) High Need Low Need No Need Don't Know Mental Health Diagnosis: (optional) High Need Low Need No Need Don't Know Mental Health Treatment: (optional) High Need Low Need No Need Don't Know Substance Abuse Treatment: (optional) High Need Low Need No Need Don't Know Substance Abuse Prevention Programs: (optional) High Need Low Need No Need Don't Know Diabetes Education: (optional) High Need Low Need No Need Don't Know Childhood Obesity and Diabetes Education: (optional) High Need Low Need No Need Don't Know Teen Crisis Intervention (Sexually-transmitted Infections, Pregnancy): (optional) High Need Low Need No Need Don't Know Adult Urgent Care: (optional) High Need Low Need No Need Don't Know Pediatric (Children) Urgent Care: (optional) High Need Low Need No Need Don't Know Mental Health Counseling: (optional) High Need Low Need No Need Don't Know Mental Health Case Management: (optional) High Need Low Need No Need Don't Know Family Support Programs: (optional) High Need Low Need No Need Don't Know Legal Services: (optional) High Need Low Need No Need Don't Know Respite Care for Children/Adults: (optional) High Need Low Need No Need Don't Know Other (Please Specify): (optional) Question 2: Would you (females) utilize the option of a free mammogram if it was available through CRRC? I would be interested in Mammogram Services through CRRC: (optional) Yes No Don't Know Question 3: Would you access basic medical screening if it was available to CRRC? I would be interested in basic medical screening at CRRC: (optional) Yes No Don't Know Question 4: Would you utilize a MHDD/MHMR counselor if they came to CRRC monthly? I would utilize a MHDD/MHMR counselor if they came to CRRC monthly: (optional) Yes No Don't Know Question 5: Do you know someone who would utilize a MHDD/MHMR counselor if they came to CRRC? I know someone who would utilize a MHDD/MHMR counselor if they came to CRRC: (optional) Yes No Don't Know Question 6: Please select the top health challenge you are facing: My top health challenge is: (optional) Cancer Diabetes Drug Addiction Overweight/Obesity Lung Disease Stroke Heart Disease Smoking Joint pain or Back pain Mental Health issues Alcohol overuse I do not have any health challenges Other (please specify): (optional) Question 7: Which of the following procedures have you had in the last year? And, which have you been told you need to have? In the last year, I have had the following procedures, or been told that I need to have: (optional) Mammogram Pap Smear Glaucoma Test Immunizations Colon/Rectal Exam Blood Pressure Check Skin Cancer Screening Prostate Check - Digital Screening Prostate Check - PSA Screening Cholesterol Screening STD (Sexually Transmitted Disease) Screening Vision Screening Hearing Screening Cardiovascular Screening Bone Density Test Dental Cleaning/X-Rays Have not had any of the above Question 8: In the last 12 months, how difficult has it been to: Find transportation to an appointment: (optional) Very difficult Difficult Not difficult Did not try/occur Find a place to get health care: (optional) Very difficult Difficult Not difficult Did not try/occur Find a health care provider/clinic I can trust: (optional) Very difficult Difficult Not difficult Did not try/occur Get Childcare: (optional) Very difficult Difficult Not difficult Did not try/occur Find services at a convenient time: (optional) Very difficult Difficult Not difficult Did not try/occur Get away from work for an appointment: (optional) Very difficult Difficult Not difficult Did not try/occur Obtain insurance coverage: (optional) Very difficult Difficult Not difficult Did not try/occur Understand medical instructions: (optional) Very difficult Difficult Not difficult Did not try/occur Find sensitive/understanding medical providers: (optional) Very difficult Difficult Not difficult Did not try/occur Make an appointment: (optional) Very difficult Difficult Not difficult Did not try/occur Find a physician that accepts your insurance: (optional) Very difficult Difficult Not difficult Did not try/occur Find a physician that speaks my language: Very difficult Difficult Not difficult Did not try/occur Find a translator: (optional) Very difficult Difficult Not difficult Did not try/occur Pay for medications: (optional) Very difficult Difficult Not difficult Did not try/occur Find money to afford a visit to the doctor/clinic/hospital: (optional) Very difficult Difficult Not difficult Did not try/occur Question 9: Which of the following class topics would be of interest to you? I am interested in the following class topics: (optional) Nutrition Healthy Cooking with Food Pantry foods Budgeting Job Applications Job Training Chronic Disease Management (COPD, Diabetes, Heart Disease, etc.) Childhood Obesity Mental/Behavioral Health Unintended Pregnancy Violence Prevention Oral/Dental Health Smoking Cessation Nutrition and Obesity Prevention Question 10: How much concern for the following do you have for our community? Alcohol Abuse (optional) High concern Low concern No concern Don't know Prevention, Diagnosis, Treatment of Asthma (optional) High concern Low concern No concern Don't know Prevention, Diagnosis, Treatment of Cancer (optional) High concern Low concern No concern Don't know Prevention, Diagnosis, Treatment of Heart Disease (optional) High concern Low concern No concern Don't know Prevention, Diagnosis, Treatment of Diabetes (optional) High concern Low concern No concern Don't know Child and Adult Immunizations (optional) High concern Low concern No concern Don't know Domestic Violence (optional) High concern Low concern No concern Don't know Child Abuse (optional) High concern Low concern No concern Don't know Obesity High concern Low concern No concern Don't know Childhood Obesity (optional) High concern Low concern No concern Don't know Teen Suicide (optional) High concern Low concern No concern Don't know Adult Suicide (optional) High concern Low concern No concern Don't know Senior Suicide (optional) High concern Low concern No concern Don't know Poor Nutrition (optional) High concern Low concern No concern Don't know Wise Budgeting (optional) High concern Low concern No concern Don't know Job Search Assistance (optional) High concern Low concern No concern Don't know Job Application Assistance (optional) High concern Low concern No concern Don't know Difficulty scheduling substance-abuse appointments (optional) High concern Low concern No concern Don't know Difficulty scheduling psychiatric appointments (optional) High concern Low concern No concern Don't know Tobacco use/smoking (optional) High concern Low concern No concern Don't know Low awareness regarding health issues (optional) High concern Low concern No concern Don't know Other (optional) Question 11: Are you aware of classes and recreational activities at the CRRC Rec Center, on the South Access Road? Are you aware of classes and recreational activities at the CRRC Rec Center, on the South Access Road? (optional) Yes No Question 12: Which of the following amenities do you think could be added to the Rec Center that you or someone in your household uses? Which of the following amenities do you think could be added to the Rec Center that you or someone in your household uses? (optional) Drinking Fountains Park Benches Security Lighting Swimming Pool Picnic Shelters Fitness/hiking/nature/biking trails Soccer fields Youth activities Whiffle ball field Lighted athletic fields Playground equipment Outdoor fitness stations Indoor gym/fitness equipment Disc Golf Course After-school programs Homework assistance Youth activities Other (optional) Question 13: What are the reasons that you or members of your household might not have participated in the Rec Center programs? (Check all that apply.) What are the reasons that you or members of your household might not have participated in the Rec Center programs? (Check all that apply.) (optional) Inconvenient time Programs not interesting Didn't find out until it was too late Fees were too high Program was already filled Program was cancelled Lack of transportation Preferred opportunities elsewhere Poor customer service Poor supervision Facilities were not well maintained Poor instruction Don't feel safe I don't participate in recreation anymore Not aware of program Need child care Other: (optional) Question 14: Which Rec Center activities have you, or a member of your household, participated in during the past year? (Check all that apply.) Which Rec Center activities have you, or a member of your household, participated in during the past year? (Check all that apply.) (optional) Celtic Dancing Line Dancing Kickboxing/conditioning Senior Programs Yoga North Pole Village Ballet - adult Ballet - children Community programs (congregate lunch. movies, cards, games, Wii) Spurs Basketball League Party for the Pantry Dance New Year's Eve Pick-up Basketball Aerobics Zumba Pickleball Softball Volleyball Western Dance Other (optional) Question 15: Which programs would you like to see at the Rec Center? Which programs would you like to see at the Rec Center? (optional) Golf Summer Camps Dance Teen programs Martial Arts Nature classes/programs Swimming classes Theater Baseball Childcare/daycare Dog Classes Fitness Football Soccer Hockey Music Rowing Swim Lessons Tennis Museum/Historical programs Other (optional) Question 16: What is your gender? What is your gender? (optional) Male Female Question 17: What is your age group? What is your age group? (optional) Below 18 years 19-40 years 41-54 years 55-59 years 60 years or older Question 18: What area of the Canyon Lake Community do you live in? What area of the Canyon Lake Community do you live in? (optional) Canyon Lake Forest Mobile Home Estates Woodlands Canyon Lake Community Center area Mystic Shores Tamarack Shores Triple Peak Village West Purgatory Eden Ranch Las Brisas Ensenada Shores Westhaven Cranes Mill North Park Jacobs Creek Fischer Startzville Sattler Canyon City Jacobs Creek Hancock Canyon Park Potters Creek Rebecca Creek Other (optional) Question 19: What is your zip code? What is your zip code? (optional) 78133 78132 78130 78623 78070 Other (optional) Question 20: What is your ethnicity? (Please select all that apply.) What is your ethnicity? (Please select all that apply.) (optional) American Indian or Alaskan Native Asian or Pacific Islander Black or African American Hispanic or Latino White / Caucasian Prefer not to answer Other Information Did you or a household member contract COVID? (optional) Yes No Were you and/or your household affected by COVID financially? If yes, how: (optional) Loss of job hours Loss of job(s) Did you apply for unemployment? (optional) Yes No Did you receive unemployment? (optional) Yes No Did you seek assistance from CRRC for COVID related expenses? (optional) Yes No Did you apply for SNAP, WIC, or other benfits during the COVID crisis? (optional) Yes No Did you apply your stimulus check to your rent or utilities? (optional) Yes No Have you applied for Medicare Supplements at CRRC? (optional) Yes No Did you vote early at CRRC for the general election in November? (optional) Yes No Your email (Required):
