Public Policy Health Awareness Survey Form
Share your views on public health policy awareness, information sources, priorities, and community engagement.
Respondent Profile
Age Range
*
Please Select
18–24
25–34
35–44
45–54
55–64
65+
General Location / Region
*
Role / Affiliation
*
Resident
Parent/Caregiver
Student
Healthcare Worker
Educator
Policymaker
Community Advocate
Other
Health Policy Awareness
How familiar are you with current local or national health policies?
*
Not at all familiar
1
2
3
4
Very familiar
5
1 is Not at all familiar, 5 is Very familiar
What are your primary sources of health policy information?
*
Government announcements
News media
Social media
Healthcare professionals
Community organizations
Workplace or school communications
Other
How much do you trust official health information?
*
1
2
3
4
5
Perceptions and Priorities
Agreement with health policy statements
*
Rows
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Access to care should be expanded for all communities.
1
2
3
4
5
Prevention programs should be a top policy priority.
6
7
8
9
10
Public education on health topics should be increased.
11
12
13
14
15
Health services should be more affordable.
16
17
18
19
20
Health policies should better address equity across populations.
21
22
23
24
25
Community outreach should be strengthened to improve awareness.
26
27
28
29
30
Which policy area should receive the most attention first?
*
Preventive care
Vaccination education
Mental health resources
Chronic disease awareness
Nutrition
Emergency preparedness
Other
Community Action and Feedback
How likely are you to participate in public health awareness activities?
*
Attend a community forum
Share information with others
Sign up for updates
Volunteer
Not likely to participate
Other
Additional comments or policy suggestions related to health awareness
Submit
Should be Empty: