Urban Planning Health Awareness Survey Form
Help us understand how urban environments impact public health by sharing your experiences and perspectives.
How would you describe your current neighborhood setting?
*
Urban
Suburban
Rural
Other
How satisfied are you with the availability of green spaces (parks, gardens, etc.) in your area?
*
1
2
3
4
5
Which modes of transportation do you use most frequently? (Select all that apply)
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Walking
Bicycle
Public Transit
Car
Other
How would you rate the air quality in your neighborhood?
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1
2
3
4
5
Please indicate your level of agreement with the following statements about your urban environment.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel safe walking in my neighborhood.
1
2
3
4
5
There are adequate facilities for physical activity.
6
7
8
9
10
Public health information is easily accessible.
11
12
13
14
15
My neighborhood encourages healthy living.
16
17
18
19
20
How often do you participate in community health or wellness events?
*
Never
Rarely
Sometimes
Often
Always
What do you believe is the most significant health challenge facing your community?
*
Please Select
Air pollution
Lack of green spaces
Limited access to healthcare
Traffic congestion
Noise pollution
Other
How informed do you feel about local urban planning initiatives that affect public health?
*
1
2
3
4
5
What improvements would you most like to see in your neighborhood to support public health?
Please share any additional comments or suggestions about urban planning and health in your area.
Submit
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