Survey Maker

PalmettoHealth.org

Thank you for visiting our website. We value your comments and suggestions to help us better understand your needs and make improvements to our website. Please take a few minutes to answer our survey questions. In return, we would like to thank you by mailing you a container of hand sanitizer.

* Indicates required information

Please provide the following information to help us best serve you.

First Name *
Middle Initial
Last Name *
Email *
Street *
City *
State *
Zip *
Phone

1. *
How often do you visit our website?
2. *
What is the purpose of your website visit today?

If Other, please specify:

3.
What parts of the website are most useful to you?
4. *
What do you like about our website?

If Other, please specify:

5. *
What don't you like about our website?

If Other, please specify:

6. *
What is your overall rating of our website?
7. *
Gender
8. *
What is your age?