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Breastfeeding Clinic Client Satisfaction Survey WDG Public Health
RequiredRequired Question(s)

Tell us how we are doing and enter a chance to win a $25 grocery gift certificate!
 
Required 1.

Which location of the Breastfeeding Clinic did you attend?
Guelph
Fergus
Mount Forest
Orangeville
Shelburne
2.

Did we help you with your problem today?
 

1000 characters left.
3.

What can we do to make the clinic better?
 

1000 characters left.
4.

Enter to win a $25 grocery gift certificate!
One draw per month. Contest ends December 31, 2012. Contestants are eligible to enter their name only once.
To enter, please provide your name and contact information. This information will only be used to contact you if you are the winner of a prize. All names and contact information will be destroyed when the contest is over. Your personal information collected from this ballot will not be linked to your survey responses.


First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com