Your feedback matters to us.

  • Your feedback matters to us.

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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.
  • 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)
  • Which service(s) are you providing your feedback about today? (Check all that Apply)
  • 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)
  • Tell us about the communication with the organization providing you service(s): (Check all that Apply)
  • Tell us about the quality of the services you receive: (Check all that Apply)
  • Tell us about the ways your services have impacted you: (Check all that Apply)

  • 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.
  • Which organization(s) are you providing feedback about today? (Check all that Apply)*
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  • Which organization(s) provided you with the service(s) you're giving us feedback about today?
  • Thank you for your time. If necessary for follow-up, may a member of the Impact Health team contact you?
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