Your feedback matters to us.
Are you a:
Healthy Opportunities Service Recipient
Parent of a Recipient
Care Manager
Human Service Organization Staff
Community Health Worker
Partner Organization
Community Member
Impact Health Staff
Other
Impact Health Staff Name
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Thank you!
Thank you for taking the time to provide us with feedback. This form will take about 5 minutes to complete. Please skip any questions you don't feel comfortable answering. All identifying information you might provide will be kept confidential.
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Your services were provided through the Healthy Opportunities Pilot (HOP). How did you first learn that you might be eligible for the services you received? (Check all that Apply)
My care manager, social worker or insurance plan
My healthcare professional (doctor/nurse/physician)
Community Health Worker (CHW)
A non-profit/faith-based/community organization
A family member, friend, acquaintance or co-worker
Billboard, Online, Radio, or TV Advertisement
A flyer, brochure, or social media
Through School or Daycare
Internet Search
I'm not sure
Other
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Which service(s) are you providing your feedback about today? (Check all that Apply)
Food
Housing
Transportation
Parenting Support
Personal Safety
Legal Services
Other
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Tell us about the timing of your service from when you were first contacted by the organization providing you service(s) (Check all that Apply)
The timing for service(s) was very quick
Service(s) started in a reasonable amount of time
My service(s) took more time to start than is reasonable
My service(s) did not start
My referral expired before I received service(s)
Other
Tell us about the communication with the organization providing you service(s): (Check all that Apply)
Communication is consistent, timely, and kind
I have a lot of different people I talk to at the organization
I feel heard by the organization when we talk
I trust the people at the organization that provides my service(s)
I am not able to get in touch with people from the organization
I do not feel like I am listened to or heard
Other
Tell us about the quality of the services you receive: (Check all that Apply)
Everything is great, I am very satisfied with the quality
Most things are great, sometimes there is an issue
Most things are not high quality, but it is mostly still useful
The quality is poor, I am not satisfied with the quality
Other
Tell us about the ways your services have impacted you: (Check all that Apply)
My services met my needs
I am grateful to have this program
The services have supported me in multiple ways
I feel more connected to my community, because of my HOP services
I feel like the organization that provides my services cares about me
My services were helpful, but I am still struggling with the same issue
My services have not impacted my needs
The services I received were harmful to me
Other
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Thank you.
At Impact Health, we aim to collect the stories of the Healthy Opportunities Pilot across Western North Carolina, thank you for taking the time to provide us with your experience.
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Which organization(s) are you providing feedback about today? (Check all that Apply)
*
ABIPA
ABCCM
ASAP
Beacon of Hope
Big Ivy Community Development
Blue Ridge Women in Agriculture
Bounty & Soul
Burke United Christian Ministries
C2Life
Caja Solidaria
Children & Family Resource Center
Community Housing Coalition of Madison County
Dayspring Foundation (Formerly Eleanor Health Foundation)
Eblen Charities
Eden of Abundance
Eliada Homes
First United Methodist Church of Waynesville
Five Points Center
Four Square Community Action
Gateway Wellness Foundation
Grahamtown Team
Haywood Christian Ministry
Haywood Pathways Center
Haywood Street Congregation
Helpmate
HIGHTS
Hinton Rural Life Center
Homeward Bound WNC
Housing Assistance Corporation
Interfaith Assistance Ministry (IAM)
Land of Sky
Legal Aid North Carolina
Macon Program for Progress
MANNA Foodbank
McDowell LFAC
Mission Ministries Alliance (MMA)
Mountain Housing Opportunities
Mountain Projects
Neighbors Feeding Neighbors Food Ministry
New Hope of McDowell
Our Voice
Pisgah Legal Services
REACH of Macon County
Reinvestment Partners
Restoration House WNC
Rutherford Housing Partnership
SAFE of Transylvania County
Safelight
Share Thy Bread (formerly Tryon Seventh Day Adventist)
Smart Start of Transylvania
Southern Reconciliation House (Rec House)
The Hunger and Health Coalition
Thrive
TRACTOR
Transylvania County Habitat for Humanity
W4H (Working Wheels) Asheville
WAMY Community Action
We Give a Share
Western North Carolina Community Health Service (WNCCHS)
Williams YMCA of Avery County
WNCSource
WNC from the Ground Up
WNC Lighthouse
YMCA of Western North Carolina
Not sure
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Please, tell us about your experience:
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how long... old
1-3 days
3-5 days
5-7 days
More than 7 days
Not sure
Which organization(s) provided you with the service(s) you're giving us feedback about today?
ABIPA
ABCCM
ASAP
Beacon of Hope
Big Ivy Community Development
Blue Ridge Women in Agriculture
Bounty & Soul
Burke United Christian Ministries
C2Life
Caja Solidaria
Children & Family Resource Center
Community Housing Coalition of Madison County
Dayspring Foundation (Formerly Eleanor Health Foundation)
Eblen Charities
Eden of Abundance
Eliada Homes
First United Methodist Church of Waynesville
Five Points Center
Four Square Community Action
Giving Spoon
Haywood Christian Ministry
Haywood Pathways Center
Haywood Street Congregation
Helpmate
HIGHTS
Hinton Rural Life Center
Housing Assistance Corporation
Interfaith Assistance Ministry (IAM)
Land of Sky
Legal Aid North Carolina
Macon Program for Progress
MANNA Foodbank
McDowell LFAC
Mountain Housing Opportunities
Mountain Projects
Neighbors Feeding Neighbors Food Ministry
New Hope of McDowell
Pisgah Legal Services
Reinvestment Partners
REACH of Macon County
Rutherford Housing Partnership
SAFE of Transylvania County
Safelight
Smart Start of Transylvania
Southern Reconciliation House (Rec House)
The Hunger and Health Coalition
Thrive
TRACTOR
Tryon Seventh Day
W4H (Working Wheels) Asheville
We Give a Share
Western North Carolina Community Health Service (WNCCHS)
Williams YMCA of Avery County
WNCSource
YMCA of Western North Carolina
Not sure
Other
5. On a scale of 1-5 'very easy to very difficult,' how easy was it to interact with the organization that provided the service(s) for you?
Very Easy
1
2
3
4
Very Difficult
5
1 is Very Easy, 5 is Very Difficult
6. How would you rate the quality of the service(s) you received from this organization?
Poor
1
2
3
4
Excellent
5
1 is Poor , 5 is Excellent
7. What, if anything, could have been better about the service(s) you received today?
8. Is there anything else you would like us to know about the service(s) you received today?
Name (optional)
First Name
Last Name
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Thank you for your time. If necessary for follow-up, may a member of the Impact Health team contact you?
Yes
No
If "yes," please provide your phone number and/or email with the best time to reach you.
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