The Wisconsin HIV/STD/HCV Information & Referral Center
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Survey

  1. Is this your first visit to www.irc-wisconsin.org?
  Yes
  No

2. How did you find www.irc-wisconsin.org?
  Saw website listed on print material (brochure, directory, other)
  From a colleague/friend /coworker
  Through an internet search
  TV/radio/billboard/bus or FocusOnTheNegative.com
  Other

3. What type of information are you seeking?
  HIV/AIDS Information
  HIV/AIDS Services or Referrals
  STD Information
  STD Services or Referrals
  Hepatitis Information
  Hepatitis Services or Referrals
  Other/Not Listed

4. Did you find what you were looking for at www.irc-wisconsin.org?
  Yes, I found the information I was seeking.
  No, I could not find the information I was seeking.
  If you answered “No,” did you know that you could call or send an email to the Wisconsin HIV/STD/Hepatitis C Information & Referral Center with your questions or information requests?
  Yes
  No
Click here to email us a question now.

5. Have you ever called the Wisconsin HIV/STD/Hepatitis C Information & Referral Center’s 24-hour anonymous toll free hotline (1-800-334-2437)?
  Yes
  No
  If you answered “Yes,” would you say that based on the service you received, you would call the Wisconsin HIV/STD/Hepatitis C Information & Referral Center’s 24-hour anonymous toll free hotline again in the future?
  Yes
  No

6. Have you ever emailed the Wisconsin HIV/STD/Hepatitis C Information & Referral Center?
  Yes
  No
  If you answered “yes,” would you say that based on the response you received, you would email the Wisconsin HIV/STD/Hepatitis C Information & Referral Center again in the future?
  Yes
  No

Please tell us about yourself.
7. You are:
  Male
  Female

8. Your age is:
  21 or under
  22-54
  55 or older

9. Are you a Wisconsin resident?
  Yes
  No
  If you answered “Yes,” please select the county you live in from the following list of Wisconsin counties:

If you have any additional comments, suggestions or feedback, please share them with us in the box below.

When you are finished, simply click on the send button below.
Your contact information will be kept confidential.
 

For More Information Call: 1-800-334-2437

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