Report Evaluation Form

Texas Department of State Health Services

The Cardiovascular Disease and Stroke Program is conducting a survey to evaluate usefulness of the Cardiovascular Disease in Texas 2012 Surveillance Report which can be accessed at:

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The Surveillance Report represents a primary source of cardiovascular disease (CVD) and stroke data for the State of Texas. There are three parts to this survey:

1. Overall demographic information about your organization.
2. Your awareness or use of The Burden Report.
3. More specific questions to gather information about the usefulness of the data report itself.

Your responses will remain confidential. It is important to provide a response to all the questions for data quality and completeness. The results will be used to improve the information we provide to our partners and others concerned about CVD and Stroke prevention and control. If you have any questions about this survey, please contact Katie Wiechnicki by email at

Thank you very much for taking the time to answer these questions. If you would prefer to submit a hard copy of the survey, mail to:

Texas Department of State Health Services
Cardiovascular Disease and Stroke Program - MC1945
Attn: Katie Wiechnicki
P.O. Box 149347
Austin, TX 78714-9347