Feedback

The New York City Department of Health and Mental Hygiene

CIR Online Feedback Form

The information and feedback you provide here will help us improve the CIR website and meet your CIR needs. If you need to report a technical problem please phone us at (212) 676-2323.

Directions:
Enter all information requested below by typing on the computer keyboard in the available spaces. Use the Tab button to move from box to box or use your mouse to point and click. Use your Space Bar to make checks within the boxes. After all of the information is entered, use the Send button at the bottom of the page to submit the form.

CIR Feedback Form
What kind of comment would you like to send? Praise Suggestion Problem Complaint What about us do you want to comment on? Registry Website Reporting CIR Services Complaint(CIR) CIR Forms Other CIR Subject (please specify) Enter your feedback, suggestions, comments in the space provided below (must be fewer than 300 characters):For other issues related to immunization, but not registry specific, please call 311.
Please provide the following contact information: First Name Last Name Title Email Organization Street Address 1 Street Address 2 City State ZIP Work Phone FAX	Today's Date Please contact me as soon as possible regarding this matter.
CLICK the button below to send your form via the internet. --or-- Print and FAX the form to (212) 676-2314 --or-- Print and MAIL the form to: 125 Worth St Box 64R New York, NY 10013-4089 --or-- CALL (212) 676-2323

Click here if you wish to obtain a voter registration form. Government services are not conditioned on being registered to vote. A voter registration form can also be obtained at http://nyc.gov/html/misc/html/register.html, or by calling (212) 868-3692.

September 2002