Tennessee Health Disparities Task Force Survey

Returning?

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Please complete the short survey below.

All Fields Are Required.

1. Complete your survey. You will have two options: You can either complete your survey by clicking on the Submit button or click Save and Return if you need to return later to your survey.

NOTE: If you choose to save and return later to your survey, please click on save and return later button which is below the submit button and you will be directed to a new page to receive a Return Code. Be sure to write this code down as you will need the survey link and the return code to return to your survey. You can also have the survey link sent to you by clicking on Send Survey Link button and entering your email address. However, for security purposes, your return code will NOT be included in the email so please write your Return code down. If you return to survey, be sure to click the Submit button to complete survey or the Continue button to continue.

2. Once you have completed step 1, and the survey has been submitted, you will go to a page to complete submission. You can click Close button which will end the survey and no further action is required.

NOTE: If you would like to receive a copy of your completed survey, you will need to either enter your email address and click Send Confirmation Email button or click the Download button at the bottom right-hand side of the page to download your completed survey.

Thank you!

Tennessee Health Disparity Task Force Survey

Personal Information:

First Name:
Last Name:
Email Address:
Phone Number:

The following questions are to collect information for the organization you are affiliated with:

Name of Organization:
Type of Organization:
Type of organization _Other:
Title at Organization:
Population Served:

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.