Kalamazoo County Health and Community Services - WIC, Online Forms: Clinic Survey

Department Home

What Is WIC?

Who Is Eligible?

Health and Community Services

WIC

Women, Infants, & Children

WIC Clinic Visit Survey
Tell Us What You Think! WIC wants to give you the best service possible; your opinion is important to us! If you have just visited a Kalamazoo County Health and Community Services WIC Clinic, please fill out the form below and click the Send button to submit. If you would rather leave general comments about how we can improve the program, please use the Improvement Form.
Clinic:	Date of visit:

What was the reason for your Clinic Visit?
Friendliness of WIC Staff
Knowledge of WIC Staff
Appearance of WIC Staff
Length of Waiting Time
Neatness/Cleanliness of Clinic/Offices
Overall Service
Additional Comments

In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discrimination on the basis of race, color, national origin, sex, age, or disability.

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Indepenedence Avenue, S.W., Washington, D.C. 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TTY). USDA is an equal opportunity provider and employer.

Health and Community Services programs are open to all without regard
to race, color, national origin, sex or disability.

Links to external sites do not constitute endorsements by Kalamazoo County.