Maine Center for Disease Control & Prevention

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CHNA Feedback

Do you have ideas or suggestions related to the Maine Shared Community Health Needs Assessment process or the plans developed based on the assessments? If so, we are interested in getting your feedback.

Shared CHNA Feedback Form

The feedback provided on this form will go to the Maine CDC. If you are providing feedback for a hospital system, it will be forwarded to contacts within that hospital.

If you want a response to your feedback, leave your contact information. Generally, we try to respond within 10 business days, but it is helpful to know any dates by which you need a response. If you are seeking additional data, use the Maine CDC's data request form.

1. For which type of report do you wish to provide comments

2. If you are responding to a CHNA report for a particular county or district, please indicate which one

3. If you are responding to a CHNA report for a particular hospital, please indicate which one

4. Did you find the information or data you were looking for?

Yes

5. What data was missing?

6. What significant health needs should hospitals and public health agencies address in the next three years?

7. What other feedback do you have about the Shared CHNA?

8. What questions do you have about the Shared CHNA?

9. Name

10. Email

11. Phone Number

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