Duval County Community Health Improvement Plan (CHIP)

Partner Contact Information and Preferences

Please complete this brief survey to ensure we have the most current contact information and preferences. If you should have any questions, please contact Celine Ginsburg at celine.ginsburg@flhealth.gov or 904-253-1489

Question Title

* 1. Contact information:

First and Last Name

Organization

Position

Email

Phone Number

Question Title

* 2. If you are interested in serving or currently serve as a member of one or more committees, please indicate below (check all that apply):

Healthy Families and Healthy Babies

Healthiest Weight

Behavioral Health

Access to Care

Question Title

* 3. If you would like to receive updates regarding one or more of the committees, please indicate below (check all that apply):

Healthy Families and Healthy Babies

Healthiest Weight

Behavioral Health

Access to Care

Question Title

* 4. Additional comments: