Community Health Initiative Feedback Poll
Share your feedback to help us improve our community health programs.
Full Name (optional)
First Name
Last Name
Email Address (optional)
example@example.com
Age Group
*
Please Select
Under 18
18-24
25-34
35-44
45-54
55-64
65+
Gender
Female
Male
Non-binary/Other
Prefer not to say
How did you participate in the Community Health Initiative?
*
Attended an event
Volunteered
Received health services
Participated online
Other
Please rate the following aspects of the initiative:
*
Rows
Excellent
Good
Fair
Poor
Organization of events
1
2
3
4
Communication and information
5
6
7
8
Accessibility of services
9
10
11
12
Relevance to community needs
13
14
15
16
Staff friendliness
17
18
19
20
Overall, how satisfied are you with the Community Health Initiative?
*
1
2
3
4
5
What positive changes have you noticed in the community as a result of this initiative?
What suggestions do you have for improving future community health initiatives?
Would you be interested in participating in similar initiatives in the future?
*
Yes
No
Maybe
Submit Feedback
Should be Empty: