DCH--How is Our Customer Service?

1. We want to continue to improve....

...so we need your feedback. Please answer the following questions so we know how we are doing. If you see a question with an *, that means it has to be answered.

1. I contacted DCH because I needed information on or from:
(Please choose all that apply.)

I contacted DCH because I needed information on or from: (Please choose all that apply.) Medicaid or any of its programs

PeachCare for KidsTM

The State Health Benefit Plan (SHBP)

Health Planning

The Certificate of Need Program (CON)

Georgia Families

Fraud and Abuse

The Health Information Technology and Transparency Initiative (HITT)

The Office of Rural Health Services (ORHS)

The Office of Health Improvement (OHI)

Budget

The DCH Board

Grants and Requests for Proposal (RFPs)

Other

Other (please specify)

2. If you contacted PeachCare for Kids TM, did you:

If you contacted PeachCare for Kids TM, did you: Call the 1-877-GAPEACH number

Contact someone at the Georgia Department of Community Health

Both

3. Date of contact:

	MM		DD		YYYY
Date:	Date of contact: Date: Month	/	Day	/	Year

4. Type of contact:

Type of contact: Phone

E-mail

Internet

5. I am a :

I am a : Member

Provider

Other

Other (please specify)

6. Please rate the service you received today based on the following scale:
1 (Strongly Disagree) through 10 (Strongly Agree).

Please answer for each of the following statements:

	1	2	3	4	5	6	7	8	9	10
We were courteous	Please rate the service you received today based on the following scale: 1 (Strongly Disagree) through 10 (Strongly Agree). Please answer for each of the following statements: We were courteous 1	2	3	4	5	6	7	8	9	10
We were helpful	We were helpful 1	2	3	4	5	6	7	8	9	10
We were knowledgeable	We were knowledgeable 1	2	3	4	5	6	7	8	9	10
We responded to you quickly	We responded to you quickly 1	2	3	4	5	6	7	8	9	10
Even if we had to tell you "no," you were treated respectfully	Even if we had to tell you "no," you were treated respectfully 1	2	3	4	5	6	7	8	9	10
Overall, I was satisfied with my contact with DCH	Overall, I was satisfied with my contact with DCH 1	2	3	4	5	6	7	8	9	10

7. Do you have a:

Do you have a: Question

Comment

Compliment

Complaint

Your input:

8. If you would like us to contact you, please provide us with:

If you would like us to contact you, please provide us with: Your name
Phone number
E-mail address

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