Food distribution Patrons Health Gaps/Needs

Hello: I am here today to ask some question about your access to health care and your health care needs so that we may possibly assist you with obtaining health coverage if you need coverage, and increasing your access to basic health screenings and health care services. Would you mind taking a few minutes to answer some questions?

Do you have any type of health insurance? If yes, What type?

When was the last time you had a physical?

Within the last six months

Within the last year

Within the last three years

Can not remember

Other

When was the last time you had your vision tesedt?

Within the last six months

Within the last year

Within the last three years

Can not remember

Other

When was the last time you were at the dentist?

Within the last three months

Within the last six months

Within the last year

Longer than a year ago

Other

When was the last time your teeth were cleaned?

Within the last three months

Within the last six months

Within the last year

Longer than a year ago

Other

Have you ever had a glucose test done? A glucose test tests for your blood sugar. level

yes

no

I don't know

Other

If yes, how long ago did you have a glucose test done?

Within the last three months

Within the last six months

Within the past year

Longer than a year ago

Other

What were the results of your glucose test?

Have you ever had a cholesterol reading?

Yes

No