Help Loving Bottoms Diaper Bank Help You!
We want to make sure our products are making a difference for you and your family. Your feedback helps us to get rid of the not so helpful stuff and make the helpful stuff more helpful. Please take a minute to fill out our survey and we promise to keep your answers private and anonymous. Thank you so much!
Where did you receive your products?
Abingdon Community Center
Jamieson Community Center
Mercer County Senior Center
Salvation Army - Canton
Salvation Army - Galesburg
VNA Community Services
War Room Ministries
Is an adult in your household working outside your home?
Does getting Incontinence supplies at this agency help you feel connected to other community services?
Does getting incontinence supplies at this agency help you feel like the community cares about your family?
Receiving these incontinence supplies for myself and/or child allows me/us to (check all that apply):
go to work each day
reduce my stress
feel comfortable during daily activities
participate in activities I enjoy (church, volunteer, etc)
buy non-food items like toothpaste or soap
I prefer to use (check all that apply):
If I don't have enough supplies I (check all that apply):
use something else
ask a friend, family member or neighbor for help
not use any product at all
receive products from an agency other than here
Is there anything you want Loving Bottoms Diaper Bank to know?
Never submit passwords through Google Forms.
This form was created inside of Loving Bottoms Diaper Bank.