* 1. Are you a:

* 2. During your most recent visit with the HCHD, what program(s) service(s) did you receive? (Please check all that apply)

* 3. Where did you learn about our available services?

* 4. Was the phone system easy to use?

* 5. Did the staff answer the phone promptly?

* 6. Was the staff courteous on the phone?

* 7. Was the staff professional in appearance?

* 8. Did you feel our lobby provided adequate privacy for your visit?

* 9. Did you know which registration desk to go to for your appointment?

* 10. Health Department staff was friendly?

* 11. The service(s) I received were delivered promptly. (<15 min. after check-in)

* 12. Health Department Staff was respectful.

* 13. I felt the side office area provided confidentiality of my visit while speaking to the secretary.

* 14. Health Department Staff was helpful.

* 15. Health Department staff took the time to listen to my concerns/

* 16. Health Department Staff understood my needs.

* 17. The Office Hours met my needs.

* 18. Overall, I am satisfied with the service(s) I received today.

* 19. I was able to get what I needed from the HCHD today.

* 20. Did Health Department Staff give you information during today's visit about other services for which you might be eligible?

* 21. Did anyone provide outstanding service? If so, whom?

* 22. What did we do well during your visit today?

* 23. What would have made your visit better for you? (please be specific)

* 24. What is the age of the person receiving service today?

* 25. Did you know you can pay for HCHD services with a credit card, and that there is a fee?

* 26. If yes, have you used a credit card to pay for services with us?

* 27. Have you visited our website: www.hchd.us?

* 28. If yes, did you find it friendly?

* 29. If yes, what did you visit our website for?

* 30. Would you like to see us on Facebook?

* 31. What is the best way to contact you for appointment reminders?

* 32. Would you recommend the HCHD to your family and friends?

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