Objectives. Develop and pilot test the Health in Community Survey (HCS), to collect patients’ perceptions of care integration between traditional care providers and community-based services that address social determinants of health. Research design. Interviews of working-age, English-or Spanish-speaking patients with multiple chronic conditions to identify survey domains; cognitive interviews and pilot test of HCS Version 1. Results. Preliminary interview subjects identified diverse care concerns. From these findings, we designed six HCS domains. Cognitive interviews identified problems relating to patients’ perceptions about limited function and disability. Nearly one-third of pilot test subjects reported they did not definitely have enough resources for food, transportation, doctor and hospital bills, and medications; 41.6% said their clinicians only sometimes or never knew about their resource problems. Conclusions. Although it requires further validation, the HCS offers insights into patients’ perceptions of care integration between traditional health care providers and services addressing social determinants of health.