Medina County Health Department Customer Satisfaction Survey

1. Tell us about your experience with the Medina County Health Department

1. On your most recent encounter with the Medina County Health Department, what program/services did you receive (please check all that apply)

On your most recent encounter with the Medina County Health Department, what program/services did you receive (please check all that apply) Dental Health visit

Women, Infants, and Children (WIC)

Adult Immunization

Child or Adolescent Immunization

Car Seat Inspection

Birth or death record

Bureau for Child with Medical Handicap (BCMH)

Well child/teen visit

Travel immunization/clinic

Doctor's visit

Environmental Health permit

Environmental Health inspection

Called for information

Was at a community health event

Other

Other (please specify)

2. Overall, how strongly do you disagree or agree with the following statments:

	Strongly Disagree	Disagree	Agree	Strongly Agree	N/A
I did not have to wait a long time to receive an appointment	*Overall, how strongly do you disagree or agree with the following statments: I did not have to wait a long time to receive an appointment Strongly Disagree	I did not have to wait a long time to receive an appointment Disagree	I did not have to wait a long time to receive an appointment Agree	I did not have to wait a long time to receive an appointment Strongly Agree	I did not have to wait a long time to receive an appointment N/A
I was greeted in a friendly manner	I was greeted in a friendly manner Strongly Disagree	I was greeted in a friendly manner Disagree	I was greeted in a friendly manner Agree	I was greeted in a friendly manner Strongly Agree	I was greeted in a friendly manner N/A
I received service(s) in a reasonable amount of time	I received service(s) in a reasonable amount of time Strongly Disagree	I received service(s) in a reasonable amount of time Disagree	I received service(s) in a reasonable amount of time Agree	I received service(s) in a reasonable amount of time Strongly Agree	I received service(s) in a reasonable amount of time N/A
I received the kind of service I needed	I received the kind of service I needed Strongly Disagree	I received the kind of service I needed Disagree	I received the kind of service I needed Agree	I received the kind of service I needed Strongly Agree	I received the kind of service I needed N/A
I am satisfied with the services I received	I am satisfied with the services I received Strongly Disagree	I am satisfied with the services I received Disagree	I am satisfied with the services I received Agree	I am satisfied with the services I received Strongly Agree	I am satisfied with the services I received N/A
I would recommend the Medina County Health Department to my friends and family	I would recommend the Medina County Health Department to my friends and family Strongly Disagree	I would recommend the Medina County Health Department to my friends and family Disagree	I would recommend the Medina County Health Department to my friends and family Agree	I would recommend the Medina County Health Department to my friends and family Strongly Agree	I would recommend the Medina County Health Department to my friends and family N/A
I would encourage my friends and family to support the Medina County Health Department	I would encourage my friends and family to support the Medina County Health Department Strongly Disagree	I would encourage my friends and family to support the Medina County Health Department Disagree	I would encourage my friends and family to support the Medina County Health Department Agree	I would encourage my friends and family to support the Medina County Health Department Strongly Agree	I would encourage my friends and family to support the Medina County Health Department N/A

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