Please tell us about your experience with the health department.

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* 1. Let us know who you are.

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* 2. Who are you letting us know about?

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* 3. Please tell us about your experience.

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* 4. Overall, how satisfied or dissatisfied are you with the service you received?

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* 5. How likely is it that you would recommend this company to a friend or colleague?

NOT AT ALL LIKELY
EXTREMELY LIKELY

T