Please Complete the short survey
below to help us evaluate the impact
on the area we operate in.
Name Optional:
Reason For Contact:
Person you wish to contact (if known):
Your E-Mail:
Desire Response?
>
No
Yes
How does the agency
impact the neighbor hood ?
>
Positively
Negitively
No Change
Do you think the crime rate in the area has changed because of the Clinic ?
>
Decreased
Increased
No Change
Does the additional traffic
caused by the agency impact you ?
>
No
Yes
Comments on opinion poll below
