Business Canvassing Report Back
Thank you for supporting the New York Health Act! By filling out this report back you are helping us collect valuable and important information because it helps us provide better resources and continually develop our strategies.

Campaign for New York Health
Ling Koh Hsu healthcareling@gmail.com

Email address *
First name *
Your answer
Last name *
Your answer
Organization/s, if applicable
Your answer
Phone *
Your answer
What neighborhood/streets did you canvass? *
Your answer
How many total businesses did you speak with? *
Your answer
How many business owners did you speak with? *
Your answer
How many businesses signed on the spot? *
Your answer
Do you need help to make a plan to follow up with the businesses that did not sign on?
Your answer
Are there questions from business owners you need answers to?
Your answer
Any meaningful experiences/connections you had with a business?
Your answer
Any challenging experiences you had with a business?
Your answer
What worked well?
Your answer
What would you update for next time?
Your answer
Comments/Feedback
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service