Jackson County Health Dept.-Customer Satisfaction Survey

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.

Question Title

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

Date:

Date

Question Title

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

Animal Shelter

Car Seat Program

Children's Special Health Care

Chronic Disease Prevention

Communicable Disease (See question #3 below)

Early On

Emergency Preparedness

Environmental Health (See question #4 below)

Hearing and Vision

Immunizations (shots)

Medicaid/MIChild

Nursing (See question #5 below)

Teen Pregnancy

Tobacco

Senior Health/Exercise

WIC

Other (please specify)

Question Title

* 3. Communicable Disease Programs Visted:

AIDS/HIV Counseling & Testing

Pregnancy Testing

STD Clinic

TB Clinic

Question Title

* 4. Environmental Health Programs Visted:

Food Service

Well/Septic

Soil Erosion

Animal Shelter

Question Title

* 5. Nursing Programs Visited:

Maternal Infant Health Program

FIMR

Other (please specify)

Question Title

* 6. Location of Service Received

Animal Shelter

Health Department

Home Visit

By Phone

Off-site Location

Other (please specify)

Question Title

* 7. Health Department Building

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

If no, why not

Question Title

* 8. Service / Program

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

If no, why not

Question Title

* 9. Employees / Staff

	Yes	No
Knowledgeable about program	Knowledgeable about program Yes	Knowledgeable about program No
Professional attitude	Professional attitude Yes	Professional attitude No
Professional appearance	Professional appearance Yes	Professional appearance No
Friendly / Polite	Friendly / Polite Yes	Friendly / Polite No
Helpful	Helpful Yes	Helpful No
Punctual / On Time	Punctual / On Time Yes	Punctual / On Time No

If no, why not

We value your comments. Please tell us more about your visit.

Question Title

* 10. What did we do well?

Question Title

* 11. What can we improve?

Question Title

* 12. How did you hear about us?

Brochure: (flyer, pamplet, notebook)

Family/Friend

Newspaper

Phone book

Radio

School

Internet

Facebook

Referral(doctor,hospital,agency)

Walk-In

Other (please specify)

Question Title

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

Name:

Address:

City/Town:

State:

ZIP:

Phone Number:

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