diversity survey feedback form

 
Thank you for visiting our website "Diversity, Healing and Healthcare." We appreciate your feedback on whether you found found the information useful.
 
 
 
 
How did you find this website
 
 
 
will you return to the website, why or why not
 
 
 
Please name three useful things
 
 
 
What would you like to see added or expanded
 
 
 
Would you recommend this site to others
 
How many times visited have you visited the site
 
What is your age
 
What is your educational level
 
 
 
If you provide healthcare, please describe your patient population
 
what is the age of patients you serve
 
In what geographic area are you located
 
What is your cultural or ethinic identity
 
 
 
If you provide care to underserved populations, please describe them