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* 1. Date of Service

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* 2. Approximate Time of Service

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* 3. What service did you received?

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* 4. Service Location

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* 5. What transportation do you usually use for your Health Department visit?

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* 6. The WIC Department was easy to find.

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* 7. The Check-in desk was easy to find.

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* 8. Office hours met my needs.

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* 9. It was easy to use the phone system.

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* 10. When I left a message on the phone system, the call was returned within one working day.

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* 11. I was scheduled for an appointment in a reasonable amount of time.

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* 12. The wait time for service was reasonable.

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* 13. The staff was friendly and courteous.

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* 14. The information given was well explained.

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* 15. The building and clinic areas were clean.

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* 16. All of my questions were answered.

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* 17. If you have visited our website www.miamicountyhealth.net, was it easy to use?

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* 18. Would you use online forms that are available on the computer from home?

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* 19. If you have any additional questions or comments, please enter them below.

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* 20. I would like a return call or email regarding my service.

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