Your Opinion Matters

Customer Satisfaction Survey

Tell Us About Your Experience

Question Title

* 1. What service did you utilize?

Clinic

HANDS

Education

Environmental

Breastfeeding Group Support

WIC

Other

Community Outreach Program (Summer Safety, Road to Reading, Baby Shower, Etc.)

Question Title

* 2. What date did you utilize this service? (an estimate is acceptable)

Date / Time

Date

Question Title

* 3. Please rate your service experience 1 to 5 stars.

Question Title

* 4. Free Space: Please tell us about your experience.