Kalamazoo County Health and Community Services - WIC, Online Forms: Improvement Form

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WIC

Women, Infants, & Children

WIC Improvement Form
We need your help to improve WIC! Please answer all the questions that apply to you and your family:
Who is currently receiving WIC coupons in your family?
Infant under 1 year Child 1 to 5 years Pregnant woman Breastfeeding woman Postpartum woman (not breastfeeding)
How long have you or your family been on the WIC Program?
Less than 6 months 6 months to 1 year 1 to 2 years More than 2 years
I think that the services I receive at WIC are:
Excellent Good Average Fair Poor
The one thing I like most about WIC is:

The one thing I do not like most about WIC is:

If I could change something about WIC it would be:

If I have a problem picking up my WIC coupons it is because:
I have no transportation I can't come during WIC office hours because of a job, school, etc. I forget that I need to pick them up I have a problem with child care Other
Are you treated fairly and courteously by the WIC staff?
Always Most of the time Sometimes Not very often Never
The WIC staff are easy to reach by telephone.
Always Usually Very hard to reach (frequently get voice mail or busy signal)
The usual waiting time to pick up my WIC coupons is about:
5 minutes 10 minutes 15 minutes 1/2 hour or more
During the last 6 months, I have talked to a nutritionist at the WIC office about my or my family's nutrition or food needs.
Yes No
The WIC nutritionist or other staff providing nutrition information:
Listened to my nutrition concerns Gave me good, practical ideas Confused me with too much information Did not provide useful information. Explain why below.
The nutrition information I received helped me or my family to:
Eat a healthy diet while I was pregnant Breastfeed my baby Feed my baby or child Understand normal eating habits of children Understand how to read food labels Decide to breastfeed Drink more milk and eat more dairy foods Eat foods high in iron Eat 5 or more servings of fruits and vegetables most days Drink more water and less sweetened drinks Save money at the grocery store Keep my family healthy Use healthy snacks Use WIC foods in cooking Plan simple and quick meals Other
I like to learn about nutrition by:
Talking with a nutritionist, nurse or doctor Talking with other WIC staff Talking with another mother who has breastfed her baby Talking with my friends about nutrition Looking at a video film Reading a newsletter Reading nutrition posters Reading a pamphlet Attending a class on nutrition
I would like to learn more about:
Saving money at the grocery store How to read food labels Choosing or buying foods to stay healthy Feeding my baby and/or child Using WIC foods Breastfeeding Good health habits Having a healthy baby Planning simple and quick meals Food safety and storage Other
If you ever missed picking up your WIC coupons for a month or longer, what were the reasons?
I didn't have transportation WIC hours were not good for my schedule I was not in town I lost my WIC ID folder I didn't need all the food or formula I didn't like coming to the WIC office I couldn't get off from work I was embarrassed to use my WIC coupons My family did not want me to get WIC coupons Not enough food on the coupons for me to come in and get them Other
ANSWER THE FOLLOWING QUESTIONS ONLY IF YOU BREAST FED OR ARE BREASTFEEDING YOUR BABY
In the first week after delivery, did someone from WIC help you with breastfeeding?
Yes No
If Yes, where or how did you receive this help?
By telephone At the hospital At the WIC office At my home
Is there anything you would have liked to learn more about:
Why breastfeeding is good for baby/mother How to get off to a good start at the hospital How to prevent sore nipples How to have good milk supply How to go to work or school and keep breastfeeding How to contact someone with breastfeeding questions Other (explain below)
If you have additional comments, please type in the space below.

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.

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