Public Health - Muskegon County
Customer Satisfaction Survey
1
. Date of service:
MM
DD
YYYY
Date of Service:
Date of service: Date of Service: Month
/
Day
/
Year
2
. Which service did you use?
Which service did you use?
Immunizations
TB Skin Test
Well/Septic Permit
WIC
STD Test/Treatment
Other (please specify)
3
. Please tell us about your experience.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I got the service or information I needed.
*
Please tell us about your experience. I got the service or information I needed. Strongly Agree
I got the service or information I needed. Agree
I got the service or information I needed. Neutral
I got the service or information I needed. Disagree
I got the service or information I needed. Strongly Disagree
The information was clear and understandable.
The information was clear and understandable. Strongly Agree
The information was clear and understandable. Agree
The information was clear and understandable. Neutral
The information was clear and understandable. Disagree
The information was clear and understandable. Strongly Disagree
The staff was friendly and polite.
The staff was friendly and polite. Strongly Agree
The staff was friendly and polite. Agree
The staff was friendly and polite. Neutral
The staff was friendly and polite. Disagree
The staff was friendly and polite. Strongly Disagree
The staff was well informed.
The staff was well informed. Strongly Agree
The staff was well informed. Agree
The staff was well informed. Neutral
The staff was well informed. Disagree
The staff was well informed. Strongly Disagree
I was helped in a timely manner.
I was helped in a timely manner. Strongly Agree
I was helped in a timely manner. Agree
I was helped in a timely manner. Neutral
I was helped in a timely manner. Disagree
I was helped in a timely manner. Strongly Disagree
Overall, I'm satisfied with the service I received.
Overall, I'm satisfied with the service I received. Strongly Agree
Overall, I'm satisfied with the service I received. Agree
Overall, I'm satisfied with the service I received. Neutral
Overall, I'm satisfied with the service I received. Disagree
Overall, I'm satisfied with the service I received. Strongly Disagree
4
. What can we improve?
What can we improve?
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