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Health declaration

Please fill out the following form.

Date of birth
Have you been hospitalized in the last 12 months?
No
Yes
Are you suffering from a medical condition, illness or injury?
No
Yes
Event Feedback \ Thank you for
participating in our event!
Tell us what you thought about it.
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How satisfied were you with the event?
What was the best part of the event?
How relevant was it for you?
How convenient were the time & place?
Would you consider coming to future events?

Thanks for your feedback!

NIECH – Network of Inner Eastern Community Houses

ABN: 74 084 095 496
ACN: A0018668T

© NIECH 2025

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