Appendix D – Provider Survey Community Health Needs Assessment Provider Survey Introduction The purpose of this survey is to hear feedback and recommendations from a broad range of people, agencies, and systems who work in the healthcare field. Your feedback will allow us to further strengthen healthcare services countywide. Please take a few minutes to complete all questions and provide responses that best fit your experiences and beliefs. Thank you in advance for your time. All responses are anonymous.
Preliminary Questions Please tell us a little about the work you do and populations you serve. 1. What is your Field of Work? ❑ Counseling/Therapy ❑ Medical Treatment/Healthcare Services ❑ Substance Use Prevention or Treatment ❑ Public Health ❑ Social Services ❑ Community-based Organization/Non-profit ❑ Pre-K through 12 Education ❑ College/Graduate Education ❑ Law Enforcement/Probation/Justice System ❑ Other (please specify): __________________________ 2. What is your agency/organization? (Dropdown list with write-in option) 3. What cities does your agency serve? (select all that apply) ❑ Aliso Viejo ❑ Corona Del Mar ❑ Costa Mesa ❑ Fountain Valley ❑ Huntington Beach ❑ Irvine ❑ Laguna Hills ❑ Laguna Niguel ❑ Laguna Woods ❑ Long Beach ❑ Midway City ❑ Mission Viejo ❑ Orange ❑ Rancho Santa Margarita ❑ Santa Ana ❑ Trabuco Canyon ❑ Tustin ❑ Villa Park ❑ All of the above
❑ Dana Point ❑ Laguna Beach ❑ Lake Forest ❑ Newport Beach ❑ Seal Beach ❑ Westminster
4. Do you provide direct services in your professional role (work directly with patients, clients, or consumers of health services)? ❑ Yes, all the time ❑ Yes, some of the time ❑ No, but others in my organization/agency do ❑ No, I do not work directly with patients, clients, or consumers of health services
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