Hamilton Health Sciences
Survey Maker

Test Survey

This is my test survey. Enjoy.

* Indicates required information

Please provide the following information to help us best serve you.

First Name *
Middle Initial
Last Name *
Email *
City *
State *
Zip *
Year of Birth (yyyy) *
Income Group

Instruction Please complete all answers.
1. *
It is snowing today.

If Other, please specify:

2. *
The weather this month is wonderful.
3. *
My favorite month for vacation is...

If Other, please specify:

4. *
Please tell me what you have retained from today.

Hamilton Health Sciences • Hamilton, Ontario • 905.521.2100

Disclaimer: Hamilton Health Sciences (HHS) offers Google Translate to better facilitate access for our community. However, HHS makes no claims regarding the accuracy of translations. Any and all health information should be verified by a health care professional.