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Satisfaction Survey of Public Health Services
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This form has been modified since it was saved. Please review all fields before submitting.
Services Received:
*
Please mark the service(s) you have received from the Public Health Division.
Women, Infants and Children (WIC)
Home Visit or Nurse Office Visit
Senior Clinic Services
Immunizations
Follow Along Program (FAP)
Car seat Passenger Safety (CPS)
Emergency Preparedness
Community/PSE Work/SHIP Work
Workplace Wellness (SHIP)
Other
Other Service Received (please specify):
The person who scheduled my appointment was pleasant, respectful, and helpful.
*
Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree
Does Not Apply
The wait time from check-in to when I was served was reasonable.
*
Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree
Does Not Apply
The appointment was helpful and informative.
*
Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree
Does Not Apply
I felt comfortable and respected during the appointment.
*
Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree
Does Not Apply
I felt I received the services I needed to help me achieve my own health goals.
*
Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree
Does Not Apply
I plan to return to use this service again in the future.
*
Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree
Does Not Apply
If you do not plan to return to use this service again in the future, why?
Please note the type of transportation you used to get to Public Health:
*
Car
Bus
Walked
Someone drove me
Does not apply
Other
Other type of transportation utilized:
Was there anything you really liked about the service you received?
What suggestions do you have to improve the services you received?
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