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Use the following form to submit your review about the BMHC
We will display it once it is approved.
Before today, when was the last time you've seen a doctor?
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An answer must be provided before moving to the next step
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Which of the following services did you use?
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Physical Health (check-ups, screenings, dental, speciality care, fitness, pharmaceutical, immunizations)
Mental Health (screenings, therapy, workshops, medication management, support groups)
Social Support Services ( transportation, food access, financial literacy, nutrition, job placement, housing)
Opportunities with BMHC (intern/extern/volunteer, research & data analysis, publishing, brand ambassador)
Has the health issue that brought you to the Black Men's Health Clinic changed since your last visit?
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Yes
No
Explain the reason for your answer
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What is your overall stress level?
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No Stress
Little Stressed
Fair
Very Stressed
Extremely Stressed
Explain the reason for your answer
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How would you rate your overall level of mental health?
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Worse
Slightly worse
Fair
Slightly better
Better
Explain the reason for your answer
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How would you rate your overall level of physical health?
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Worse
Slightly worse
Fair
Slightly better
Better
Explain the reason for your answer
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All questions must be answered before moving to the next step
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What is your overall impression of the Black Men's Health Clinic?
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Did the medical provider meet your expectations?
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Yes
No
Explain the reason for your answer
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Did the medical care meet your needs?
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Yes
No
Explain the reason for your answer
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Did the outreach and engagement team provide a strong support system?
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Yes
No
Explain the reason for your answer
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All questions must be answered before moving to the next step
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Name
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Email
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Hi! Are you a:
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Returning Client
