Wisconsin Public Health Hotlines
Web Site Survey
Section One: Your Feedback
1. Did you find the site easy to use?
--Pick from list--
Yes
No
N/A
If not, can you tell us which steps you had trouble with and suggest what would make the site easier to use?
2. Which Section(s) of the web site did you visit?
Check all that apply:
Maternal and Child Health Hotline
Wisconsin First Step
Children w/Spec. Health Needs Rgnl. Ctrs.
Birth to 3 Program
Resource House Database Search
3. Were you able to find what you were looking for in the site?
--Pick from list--
Yes
No
N/A
If no, please describe what you were unable to find.
4. Which term best describes the performance of this site?
--Pick from list--
More than acceptable
Acceptable
Slow
N/A
Section Two: Tell Us About Yourself
1. Age:
--Pick from list--
Under 17
18 - 29
30 - 49
50 - 64
65 - 84
85+
N/A
2. Gender:
--Pick from list--
Female
Male
N/A
3. Are you pregnant or think you may be pregnant?
--Pick from list--
Yes
No
N/A
If yes, did you utilize the Pregnancy Self Assessment Tool on the home page of this site?
--Pick from list--
Yes
No
N/A
4. Do you or a family member have a disability?
--Pick from list--
Yes
No
N/A
If you are willing, please tell us about you or your family member's disability.
5. Are you looking for information for:
(check all that apply)
Yourself
Your Spouse
Parent
Child(ren) under 18
Child(ren) over 18
Grandchild(ren)
Section Three: Suggestions
Please describe any other suggestions for changes for this site.