Community Health Needs Assessment Form

Add Your Voice to the Project! The goal of the Community Health Needs Assessment project is to help identify the greatest health needs in the Self Regional Healthcare seven-county service area.
  • Which of the following key areas of community health are most important to you? *
  • Please share your thoughts with us based on your selections above. Consider what you feel to be some of the community's major health concerns, or what factors keep the community from being healthier.
  • OPTIONAL: please provide a name if you'd like to be available for followup questions and discussion.
  • OPTIONAL: provide an email address or telephone number if you'd like to be available for followup questions and discussion.