Thank you for providing feedback on your WV WIC Clinic experience. Contact information is not required, but this information does help our office in resolving your issue as fast as possible. All contact information is confidential. This institution is an equal opportunity provider.

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* 1. Clinic Location

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* 2. On a scale of 1 to 5, with 1 being the worst and 5 being the best, how would you rate your experience at your clinic location?

1 5
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i We adjusted the number you entered based on the slider’s scale.

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* 3. On a scale of 1 to 5, how would you rate the WIC staff you interacted with during your clinic experience?

1 5
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i We adjusted the number you entered based on the slider’s scale.

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* 4. Please list below any additional comments about your clinic visit. Please include all details such as names, dates, etc.

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* 5. If you feel as though you were discriminated against while at this clinic location, please leave a comment here describing what happened. You can also click here to file a program discrimination complaint.

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