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Client Feedback Form
Client Feedback Form
You must have JavaScript enabled to use this form.
How was our service for you?
Date of service
Date
What service or program did you receive?
I was able to receive public health programs or services in the official language (English/French) I am most comfortable
- None -
- None -
Yes
No
- None -
Yes
No
The public health services I received met Accessibility for Ontarians with Disabilities Act (AODA) requirements.
- None -
- None -
Yes
No
Unsure
- None -
Yes
No
Unsure
What would you like to tell us about your experience?
Please provide your contact information if you'd like to discuss your experience.
Name
Phone Number
Email
