• Environmental and Injury Epidemiology and Toxicology Branch  Response Form

    We'd like to hear from you!

    Simply fill out the form, then click on the Submit Form button.

    Information about you (optional):





         
    Phone   ( ) -   - 







    1. Select what you are responding to (choose only one):

         





    3. Date of document, meeting, or presentation (if applicable):
             

    4. Was the document, meeting, or presentation easy to understand?

           







    5. Did this document, meeting, or presentation help you to better understand your risk of exposure to chemicals?

             







    6. As a result of this document, meeting, or presentation, do you plan to take actions to reduce your risk of exposure to chemicals?







    7. How could this document, meeting, or presentation have been improved?





    8. Other comments on this document, meeting, or presentation?




    We appreciate your response.

    PRIVACY NOTIFICATION: With few exceptions, you have the right to request and be informed about information that the State of Texas collects about you. You are entitled to receive and review the information upon request. You also have the right to ask the state agency to correct any information that is determined to be incorrect. See http://www.dshs.state.tx.us for more information on Privacy Notification. (Reference: Government Code, Section 552.021, 552.023, 559.003 and 559.004).


    top of page

Last updated December 16, 2010