If there is an asterisk "*" at the end of question, it means an answer is required. We ask that you complete questions 1-6. Questions 7, 8, and 9 are optional.
1. What type of organization do you represent (check all that apply):
Local Health Department
State or Local Coalition
Community Health Organization
Hospital, Clinic, Practice, or Medical Facility
Academic Institution (College, University)
Medical/Health Professional Association
Faith Based Organization
Person with Asthma
(Enter up to 40 characters.)
2. Name of organization:
If you can see this field, please leave it blank.
3. What is your position in the organization (check all that apply): *
4. How will you use this report (check all that apply): *
5. For each statement below, please select the choice that best reflects your opinion: *
a. This report is clear and easy to understand.
b. This report is well-organized.
c. This report has improved my understanding of Asthma in North Carolina.
d. This report will be useful to me in my work.
6. Please rate the usefulness of each section: *
a. The Executive Summary was:
b. The Introduction was:
c. The Asthma Prevalence section was:
d. The Asthma Management and Quality of Life section was:
e. The Health Care Utilization section was:
f. The Mortality section was:
g. The Healthy People 2010 section was:
h. The Discussion, References, and Technical Notes were:
i. The Appendices were:
7. Please list any other content areas that you would like to see in future editions:
8. Please list any organizations (name, phone #) you feel would benefit from this report:
9. Other comments/questions/suggestions:
To finish recommending the site, please complete the reCAPTCHA image verification challenge below (if displayed) and press the "Submit Evaluation" button.
using your local, client-based email program or a web-based email program. Return to the Asthma Home Page
Why are you being asked to complete the reCAPTCHA challenge? The reCAPTCHA, 3rd-party image verification tool helps identify the user as a human (rather than a spam-generating computer) and reduces the likelihood of this form being used for unintended purposes.
reCAPTCHA Quick Help:
If you use the audio challenge, type the numerals/digits without spaces (do not spell out the numbers).
If you use the image-based challenge each word you type should be separated by a space.
If you don't like your challenge, click the refresh button to the right of the response field to get a new one.
If you need further help, click the question mark ("?").
Why are there 2 words in the reCAPTCHA puzzle? A full summary can be found at http://www.google.com/recaptcha/learnmore.
Solving the reCAPTCHA puzzle improves the process of digitizing scanned books by sending words that cannot be read by computers via Optical Character Recognition (OCR) to the Web in the form of CAPTCHAs for humans to decipher.
Disclaimer: Use reCAPTCHA, a third-party tool, at your own risk. The Asthma Program has no control over the images/words displayed in the reCAPTCHA.
The Asthma Program does not monitor nor does it have any control over the reCAPTCHA service, apart from the inclusion of the service in this web page as a verification mechanism. The Asthma Program does not endorse or adhere to views or opinions expressed or perceived by any of the images/words in the reCAPTCHA tool. The Asthma Program does not endorse or adopt reCAPTCHA images/words and can make no guarantee as to their accuracy or completeness. The Asthma Program undertakes no responsibility to update or review any reCAPTCHA images/words.
If you do not agree with the use of the reCAPTCHA or if you find reCAPTCHA words offensive, you may use the
of the evaluation. PDF version