1. Jackson County Health Department

Customer Satisfaction Survey
DEDICATED to Creating Healthy Communities

Dear Valued Customer:
The Jackson County Health Department cares about the quality of service you receive. Please take a moment to fill out this Customer Satisfaction Survey to help us make any needed improvements and to recognize the programs you find satisfactory. Your opinions and suggestions are greatly appreciated. This evaluation will help us to serve your better.

Thank you for your assistance.

Richard Thoune, RS,MS,MPH
Health Officer/Director of Health Integration

Jackson County Health Department's mission is working together to create and promote a healthy community through disease prevention and control, health education, environmental protection, and emergency preparedness.

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* 1. Date of service (if you know it)

Date:

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* 2. Program(s) Visited: If you visited more than one program, please click all that apply.

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* 3. Communicable Disease Programs Visted:

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* 4. Environmental Health Programs Visted:

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* 5. Nursing Programs Visited:

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* 6. Location of Service Received

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* 7. Health Department Building

  Yes No
Easy to find
Was the building clean
Parking space available
If assistance was needed upon entering the building, did you receive it?
If you phoned, was the phone system easy to use?

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* 8. Service / Program

  Yes No
Easy to find in building
Comfortable waiting room
Appropriate waiting time
Office hours meet your needs
Service/Program met your needs

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* 9. Employees / Staff

  Yes No
Knowledgeable about program
Professional attitude
Professional appearance
Friendly / Polite
Helpful
Punctual / On Time
We value your comments. Please tell us more about your visit.

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* 10. What did we do well?

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* 11. What can we improve?

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* 12. How did you hear about us?

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* 13. (OPTIONAL) For follow-up use only:

We value your opinion! Thank you for participating in our short survey.

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