Customer Feedback and Suggestion Box

Thank you for taking the time to complete this survey. The purpose of this survey is to gather feedback in regard to ABCHD on an ongoing basis. This feedback can be things we are doing well or opportunities for improvement. All responses are anonymous and information will be reviewed regularly. Please complete one survey response for each of your suggestions.

Question Title

* 1. Please indicate what section your feedback pertains to:

Administrative

Breastfeeding

Clinic

Environmental

HANDS

Health Education and Prevention

Vital Statistics

WIC

Other (please specify)

Question Title

* 2. Please provide your feedback in the comment box provided below:

Question Title

* 3. Optional: Please leave your name, email, phone number if you wish to be contacted for follow-up. Thank you.