Shield-Net: Medical Facility Feedback Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Shield-Net: Medical Facility Feedback Form

Sign in to Google to save your progress. Learn more

* Indicates required question

Email *

Your email

What is your respondent ID? (located in the email you received with the subject: [Face Shield Matching Feedback]) *

Your answer

Was your previous match to a manufacturer successful? *

Yes

No

Next

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy