BVCOG HIV/Health Services Feedback Form

The following form will allow you to provide anonymous feedback to the Brazos Valley Council of Governments (BVCOG) HIV/Health Services division. You will only be asked to provide an email address if you wish to receive emails about BVCOG HIV/Health Services planning activities.

Your feedback is in no way traceable to you and will not affect your access or eligibility for services. Please be as specific and open as possible, as your feedback helps shape HIV Services funding and planning for your area.

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* 1. Please provide comment(s) here.

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* 2. Which Health Service Delivery Area (HSDA) best describes where you live or receive services?

Austin HSDA (Bastrop, Blanco, Burnett, Caldwell, Fayette, Hays, Lee, Llano, Travis or Williamson County)

Bryan-College Station HSDA (Burleson, Brazos, Grimes, Leon, Madison, Robertson or Washington County)

Concho Plateau HSDA (Coke, Concho, Crockett, Irion, Kimble, McCulloch, Mason, Menard, Reagan, Schleicher, Sterling, Sutton or Tom Green County)

Temple-Killeen HSDA (Bell, Coryell, Hamilton, Lampasas, Milam, Mills or San Saba County)

Waco HSDA (Bosque, Falls, Freestone, Hill, Limestone or McLennan County)

I do not live or receive services in any of these counties

Other (please specify)

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* 3. Would you like to receive emails about BVCOG HIV/Health Services planning activities? This allows you to review and provide feedback on planning products. Your email address will not be shared.

Yes

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* 4. If yes, please enter your email address (optional).

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* 5. How can we improve this anonymous feedback form?

Thank you for taking the time to fill out this form! Your feedback helps shape HIV Services funding and planning for your community.