The following statements relate to the services you receive from WIC.

All responses will be kept confidential and will not be viewed individually by WIC staff. Please provide your honest feedback as we would like to use this information to serve you in the best way possible.

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* 1. WIC staff were friendly.

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* 2. WIC staff were helpful.

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* 3. WIC staff treated me with respect.

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* 4. WIC staff took the time to listen to my concerns.

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* 5. WIC staff helped me feel relaxed or at ease during my appointment.

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* 6.  WIC staff used words that I could understand.

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* 7. Printed materials that I received were easy to read and understand.

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* 8. The services I received met my needs. (including social, cultural, and/or special needs)

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* 9. I felt my privacy was protected by WIC staff.

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* 10. WIC services were provided in a timely manner.

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* 11. Our main office is open Monday-Friday 8:00am-4:30pm. Do these hours meet your needs?

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* 12. If you marked no to question #11, which of the following hours would better meet your needs?

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* 13. Which WIC location do you most often attend?

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* 14. Do you have any of the following barriers that prevent you from getting to your WIC appt or getting your WIC card reloaded. Check all that apply.

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* 15. It was found that WIC participants are not redeeming their food benefits the the fullest. Are there barriers that prevent you from purchasing WIC foods? Check all the apply.

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* 16. How far is the nearing WIC authorized grocery store from your home?

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* 17. If local convenience stores accepted the eWIC card, would you be able purchase more WIC foods? (By convenience stores we mean gas stations, dollar stores)

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* 18. What did we do well during your most recent visit?

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* 19. What, if anything, did you feel was negative at your most recent visit that we could improve on?

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* 20. I would recommend the WIC program to my friends and family.

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* 21. Overall I am satisfied with the services I received from the WIC program.

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* 22. Did WIC staff offer you information during your most recent visit about other services you might need?

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* 23. I am likely to return to WIC for services.

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* 24. How do your prefer to receive information?

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* 25. How did you hear about our services?

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* 26. What is your gender?

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* 27. What is your current age?

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* 28. What is your race? (Choose all the apply)

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* 29. How many children under the age of 18 live in your household?

Thank you for your valuable input. If you have any questions regarding this survey, please contact the Juneau County Health Department at 608-847-9373.

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