Community Health Needs Assessment Survey

Understand Your Community's Health Needs with Paperform

Community health organizations, public health departments, and healthcare providers know that effective programs start with understanding the real needs of the people they serve. This Community Health Needs Assessment Survey template helps you gather comprehensive data about health priorities, access barriers, social determinants of health, and program improvement opportunities—all in one well-designed, easy-to-complete form.

Why This Template Works for Healthcare Organizations

Whether you're a community health center conducting your triennial assessment, a nonprofit planning new health initiatives, or a public health department evaluating service gaps, this template gives you a structured framework to collect actionable insights. The form balances quantitative data (through ranking and rating scales) with qualitative feedback, giving you both the numbers and the stories behind them.

Built with Paperform's flexible design capabilities, this survey maintains a professional, accessible feel that encourages completion while gathering the depth of information you need for grant applications, strategic planning, and community-driven program development.

What Makes This Template Special

This assessment goes beyond basic health surveys by incorporating:

Health Priority Ranking – Understand which health issues matter most to your community through drag-to-rank questions that reveal true priorities rather than just checkboxes.

Comprehensive Barrier Analysis – Identify specific obstacles preventing community members from accessing healthcare, from transportation and cost to language barriers and cultural concerns.

Social Determinants Screening – Capture critical context about housing stability, food security, employment, education, and social support that directly impact health outcomes.

Program Feedback – Gather actionable suggestions for improving existing services and developing new programs that meet real community needs.

The form uses conditional logic to create a personalized experience—respondents only see follow-up questions relevant to their situations, keeping the survey efficient while maximizing data quality.

Perfect for These Healthcare Professionals

This template is ideal for:

• Community Health Centers conducting HRSA-required needs assessments
• Public Health Departments planning population health initiatives
• Hospital Systems completing Community Health Needs Assessments for IRS compliance
• Nonprofit Health Organizations designing targeted intervention programs
• Health Coalitions gathering data for grant applications and strategic planning
• Social Workers and Case Managers screening for social determinants of health

Streamline Your Data Collection and Analysis

With Paperform, your community health assessment becomes more than just a survey—it becomes an engine for action. Responses flow automatically into your preferred analysis tools through native integrations with Google Sheets, Airtable, or your existing database.

Use Paperform's AI Insights to quickly identify themes and trends across hundreds of responses, turning raw data into clear talking points for stakeholder presentations, grant narratives, and community reports. The AI can summarize common barriers, group program suggestions by theme, and highlight unexpected findings—analysis that would typically take hours happens in minutes.

For organizations managing multiple assessment initiatives, responses can trigger Stepper workflows to segment data by neighborhood, route urgent needs to case management teams, or automatically update program planning dashboards in real time.

Accessible, Mobile-Friendly Design That Respects Your Community

Healthcare equity starts with accessible data collection. This template is fully mobile-responsive, ensuring community members can participate whether they're using a smartphone, tablet, or computer at your facility. The clear, conversational language makes the survey approachable for diverse literacy levels, and Paperform's multi-language support lets you offer the assessment in the languages your community speaks.

Embed the survey on your website, share it via social media and email campaigns, or display it on tablets at community events and clinic waiting rooms. All responses sync to one central database regardless of how people access the form.

HIPAA Considerations and Privacy

While Paperform is not HIPAA compliant, this community health needs assessment template is designed to collect aggregate population health data rather than individual protected health information. The form asks about general health experiences, community needs, and demographics without collecting names, birthdates, or other identifiers that would constitute PHI.

For organizations that need to maintain an audit trail or collect consent, you can easily add Papersign integration to capture electronic signatures on participation consent forms, keeping everything organized in one workflow.

Data-Driven Health Equity

This template helps you move beyond assumptions and truly listen to your community. By systematically collecting data on health priorities, access barriers, and social determinants, you can:

• Identify service gaps where community needs don't match available programs
• Prioritize limited resources based on actual community input rather than provider perception
• Strengthen grant applications with compelling, current community data
• Build trust by demonstrating that community voice shapes your programs
• Track progress by repeating assessments to measure how barriers and needs evolve

Whether you're a small community health nonprofit or a large hospital system, this template provides the foundation for meaningful community engagement and health equity initiatives. Start collecting the insights you need to build healthier communities—no coding or complex survey software required.