Frontier Community Coalition
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Healthy
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Nevada Survey for Community Health 2011

    Once you have responded to each question on the form, please click the "Submit" button at the end of the form to submit your responses to the coalition staff. Thank you for participating in the community health survey.

   
   
   
   
   
           
       
   
   
    Older Siblings:
    Parents:
    Friends:
    Adults/Strangers:
   
   
   
   
           
         
   
       
          Anything else?
   
   
   
   
   
   

Some of the questions that follow ask about your own behavior. We will keep your responses completely anonymous; please answer them as accurately as possible.

   
   
   

Please think about the differences between the way our community is now and the way it was two years ago. In the last two years...

   
   
   
   
   

** If you are under 21 years or age, please answer these additional questions.
If you are over 21 years of age, please submit your survey now. Thank you! **


   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   


This website was funded in part by the Mental Health Division, Substance Abuse Prevention and Treatment Agency and SAMSHA.

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