Community Health Needs Assessment Survey 2026

Community Health Needs Assessment Survey 2026
Please take a few moments to complete this 10-question survey. As a 501(c)(3) nonprofit organization, we are committed to the health and well-being of our community and to understanding the needs of those we serve. We are conducting a Community Health Needs Assessment (CHNA) to better understand how community health needs are being met, identify areas of concern, and determine opportunities to improve health outcomes across our community. Your feedback is greatly appreciated and helps guide our future efforts.

Providing contact information is optional and only needed if you wish to be entered into the drawing for a $100 visa gift card.

Survey closes on 01/12/2026.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
What zipcode / town do you reside in?*
1. How would you rate the general health of our community?*

Very HealthyHealthySomewhat HealthyUnhealthyVery Unhealthy
2. What are the three most pressing health concerns in the community? (Select 3)*

Mental HealthHeart DiseaseOpioid AddictionStrokeAlcohol AbuseCancerIllegal Drug UseLack of SleepTobacco/Smoking/VapingObesity & DiabetesOther
3. In your opinion, what would improve our community’s access to healthcare? (Select 3)*

More Primary CareGreater Health EducationMore Physician SpecialistsInterpreter ServicesTelemedicineCultural AwarenessCharity CareTransportation AssistanceOther
4. Which organization does your household use the MOST for Hospital Services - Example: ER, Radiology, Lab, Surgery, Inpatient, etc.?(Please select 1)*

Uintah Basin HealthcareAshley Regional Medical CenterUniversity of Utah HealthIntermountain HealthcareOther
5. Which organization does your household use the MOST for Clinic Services?

UBH Urgent Care (Roosevelt or Vernal)ARMC Physician ClinicsVernal Urgent Care (Hwy 40)Independent Physician ClinicsUBH Physician ClinicsOther
6. Thinking about the healthcare organization you use most frequently, what are the five most important reasons for selecting that organization? (Select 5)*

Cost of CareLocationTrust in ProviderTechnology DrivenPositive Patient ExperienceRecommend by Family or FriendsQuality of CareOnline Scheduling/PortalEfficient Billing ProcessRequired by Insurance PlanLocally OwnedInvested in CommunityOther
7. What can Uintah Basin Healthcare do to better meet the health needs of our community?*
8. What type of additional physician specialists or expanded services would you like to have MOST in our community?*
9. If you have ever delayed getting healthcare, what were the three most important reasons why you did not receive healthcare services? (Select 3)*

CostScheduling IssuesPoor Insurance CoveragePoor Patient ExperienceUninsuredNo Online SchedulingBilling IssuesLanguage BarrierUnsure of Services OfferedTransportation IssuesPersonal Time ConflictOther
10. How do you learn about health related services or events? (Select all that apply)*

WebsitesChurch/Community AnnouncementOnline AdvertisingWord of Mouth/ReputationSocial MediaPrinted NewspaperDigital NewsBillboards/SignageRadioHealth Provider/Public HealthMailingsOther
Please verify that you are human*
Should be Empty: