COVID 19 Impact Feedback Form

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

COVID 19 Impact Feedback Form

Namaskar and Kia Ora,

Please feel free to share your thoughts, suggestions or recommendations to the Government of New Zealand regarding the impact you or anyone in your community had through COVID 19 community transmission and disruption. The feedback received will be directly shared with the Government of New Zealand through the Principal Advisor of the Ministry of Health, New Zealand.

Sign in to Google to save your progress. Learn more

* Indicates required question

Name

Your answer

Email

Your answer

Your feedback on the impact of COVID 19 *

Your answer

Submit

Clear form

Never submit passwords through Google Forms.

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