Please take a few minutes to complete this survey on the quality of services we provide. This survey is anonymous. Refusal to take this survey will in no way affect your eligibility for or receipt of Georgia WIC services. If a question does not apply to you or if you do not know the answer, please select “Does not Apply”.

You may choose to complete this survey online ( or by completing this form and either placing it in the Comment Box or mailing it to: Georgia WIC Program, Two Peachtree Street, NW., Suite 10-476, Atlanta, Georgia 30303.

* 1. For each item listed below, please indicate your level of agreement by selecting the response that most
closely describes your recent experiences with Georgia WIC. (Select one option for each item below)

  Strongly Agree Agree Neutral Disagree Strongly Disagree Does not Apply
Overall, I am satisfied with my WIC services
I am satisfied with the amount of time it took to complete my last WIC appointment
It was difficult to schedule my last WIC appointment
The WIC staff treat me with respect
I feel comfortable asking the WIC staff for help
My nutrition counselor is knowledgeable about health and diet
My nutrition counselor is knowledgeable about breastfeeding
I have enough time to talk to my nutrition counselor
WIC benefits are worth the time required to certify (or re-certify) for WIC
The information I receive at WIC is easy to understand
I use the information I learn at WIC
There is a grocery store conveniently located near me that accepts WIC vouchers
Please proceed to Question 2

* 2. Do you have access to the internet on your phone?

* 3. Do you have access to the internet from a computer?

* 4. Have you received any WIC vouchers yet?