Resource Snapshot Feedback Form

Thank you for accessing the New York City Department of Health and Mental Hygiene's (NYC Health Department) neighborhood-based resources. We want to make sure these guides are relevant to you and the communities you serve. Please use this form to share feedback, questions or concerns related to the snapshots.

1. Which best describes you? *This question is required.

2. Your name *This question is required.

2. Which organization? *This question is required.

2. ZIP code of organization: *This question is required. This question requires a valid number format.

2. Contact information *This question is required.

Name:
Best way to contact you (email address or phone number):

Please note: This form is related to the neighborhood-based resources. If you would like to submit a COVID-19 related request or inquiry to the NYC Health Department, please fill out this form.

2. Please list your ZIP code: *This question is required. This question requires a valid number format.