HCHD Agency Survey Question Title * 1. Are you a: New Client Returning Client Question Title * 2. During your most recent visit with the HCHD, what program(s) service(s) did you receive? (Please check all that apply) WIC Immunizations CSHCS BCCCP Other Family Planning Environmental Health MIHP Question Title * 3. Where did you learn about our available services? Friend/Family Existing HCHD Client Brochure/Flyer HCHD Website School Newspaper/radio Other Other (please specify) Question Title * 4. Was the phone system easy to use? Yes No NA Question Title * 5. Did the staff answer the phone promptly? Yes No NA Question Title * 6. Was the staff courteous on the phone? Yes No NA Question Title * 7. Was the staff professional in appearance? Yes No NA Question Title * 8. Did you feel our lobby provided adequate privacy for your visit? Yes No NA Question Title * 9. Did you know which registration desk to go to for your appointment? Yes No NA Question Title * 10. Health Department staff was friendly? Yes No NA Question Title * 11. The service(s) I received were delivered promptly. (<15 min. after check-in) Yes No NA Question Title * 12. Health Department Staff was respectful. Yes No NA Question Title * 13. I felt the side office area provided confidentiality of my visit while speaking to the secretary. Yes No NA Question Title * 14. Health Department Staff was helpful. Yes No NA Question Title * 15. Health Department staff took the time to listen to my concerns/ Yes No NA Question Title * 16. Health Department Staff understood my needs. Yes No NA Question Title * 17. The Office Hours met my needs. Yes No NA Question Title * 18. Overall, I am satisfied with the service(s) I received today. Yes No NA Question Title * 19. I was able to get what I needed from the HCHD today. Yes No NA Comment: Question Title * 20. Did Health Department Staff give you information during today's visit about other services for which you might be eligible? Yes No Question Title * 21. Did anyone provide outstanding service? If so, whom? Question Title * 22. What did we do well during your visit today? Question Title * 23. What would have made your visit better for you? (please be specific) Question Title * 24. What is the age of the person receiving service today? < 5 years 5-10 years 11-15 years 16-20 years 21-30 years 31-40 years 41-50 years 51-60 years 61-70 years > 70 years Question Title * 25. Did you know you can pay for HCHD services with a credit card, and that there is a fee? Yes No Question Title * 26. If yes, have you used a credit card to pay for services with us? Yes No Question Title * 27. Have you visited our website: www.hchd.us? Yes No Question Title * 28. If yes, did you find it friendly? Yes No Question Title * 29. If yes, what did you visit our website for? Question Title * 30. Would you like to see us on Facebook? Yes No Question Title * 31. What is the best way to contact you for appointment reminders? Text Message Letter by Mail Phone Call / Voice Mail Email Other Other (please specify) Question Title * 32. Would you recommend the HCHD to your family and friends? Yes No Done