2019 Shared Community Health Needs Assessment Comments Form
Time Elapsed:
0
minutes
Time Remaining:
0
minutes
Total Time:
0
minutes
Anonymous Login Code:
Save this code, which is required to update your response at a later time.
Page 1 of 1
General Information
Northern Light Health welcomes your comments on the 2019 Shared Community Health Needs Assessment (CHNA). To provide us with written online feedback, please complete the form below.
1.
Your name (first and last)
*
2.
Street Address
3.
City
4.
State
5.
Zip
6.
Email Address
*
7.
For which type of report do you wish to provide a comment:
*
Statewide Shared Community Health Needs Assessment Report
County Shared Community Health Needs Assessment Report
County Health Profile
Urban Level Report (Bangor, Portland, Lewiston/Auburn)
8.
Please select the county (or counties) below for which you would like to provide comment. Select the Statewide Report option to provide a comment on the statewide report. Select the Urban Level Report option to provide a comment on the urban level reports.
*
If needed, select more than one report below:
Statewide Report
Androscoggin
Aroostook
Cumberland
Franklin
Hancock
Kennebec
Knox
Lincoln
Oxford
Penobscot
Piscataquis
Sagadahoc
Somerset
Waldo
Washington
York
Urban Level Reports (Bangor, Portland, Lewiston/Auburn)
9.
Your comments:
*