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Norfolk Community Health Survey 2015

  1. Please take a minute to complete the survey below. The purpose of this survey is to better understand your views on community health in Norfolk. The Norfolk Community Advisory Board will use the results of this survey and other information to identify the most pressing issues to be addressed together as a city.
  2. 4. What do you think are the 3 most important characteristics of a “healthy community”?
  3. 5. What do you think are the 3 most important “health problems” that must be addressed to improve health and quality of life in our community?
  4. 6. What do you think are the 3 “risky behaviors” that need to be addressed the most in our community?
  5. 7. Please select the option that best describes the health of our community.
  6. 8. Please select the option that best describes your own personal health.
  7. 9. Do you believe that you can help improve the health of our community?
    1. Please provide the following information. It will be used for demographic purposes only.
    2. 11. Are you Hispanic or Latino?
    3. 12. Your Age:
    4. 13. Marital Status
    5. 14. How do you describe yourself? (check one)
    6. 15. Which one of these groups would you say best represents your race?
    7. 16. Household Income:
    8. Would you like to receive updates about the survey results and our effort to improve health in Norfolk? Would you like to be involved in this effort? If yes, please provide your email address or phone number.
    9. Thank you very much for your response!
      If you would like more information about this community project, please contact Nancy Cisco of Norfolk Department of Health Public Health. Email:
      Phone: 757-683-2737.
    10. Leave This Blank:

    11. This field is not part of the form submission.