Putnam County Health Department's Customer Satisfaction Survey

Welcome to PCHD's Customer Satisfaction Survey! It is our goal to provide an excellent experience to the residents of Putnam County and all who seek our services. Your feedback will help us to improve our service to you. Your answers are anonymous.

Question Title

* 1. Date of Service

Date / Time

Date

Question Title

* 2. The main service I received was:

Immunizations

Birth/Death Certificates

Complex Medical Help (CMH)

Car Seat

Health Promotion/Community Outreach

Animal Bite

Food Service/Safety

Septic/Sewage

Septic - Operation and Maintenance Program (O&M)

Water/Well Program

Other (please specify)

Question Title

* 3. Please rate your experience:

	Excellent	Very Good	Acceptable	Needs Improvement	Poor	Not Applicable
Staff Courtesy and Respect	Staff Courtesy and Respect Excellent	Staff Courtesy and Respect Very Good	Staff Courtesy and Respect Acceptable	Staff Courtesy and Respect Needs Improvement	Staff Courtesy and Respect Poor	Staff Courtesy and Respect Not Applicable
Staff Knowledge & Information Provided	Staff Knowledge & Information Provided Excellent	Staff Knowledge & Information Provided Very Good	Staff Knowledge & Information Provided Acceptable	Staff Knowledge & Information Provided Needs Improvement	Staff Knowledge & Information Provided Poor	Staff Knowledge & Information Provided Not Applicable
Quality of Service	Quality of Service Excellent	Quality of Service Very Good	Quality of Service Acceptable	Quality of Service Needs Improvement	Quality of Service Poor	Quality of Service Not Applicable
Timely Communication	Timely Communication Excellent	Timely Communication Very Good	Timely Communication Acceptable	Timely Communication Needs Improvement	Timely Communication Poor	Timely Communication Not Applicable

Question Title

* 4. If you noted (Needs Improvement OR Poor) above, how can we improve our services.

Question Title

* 5. Is there a staff member that you would like to recognize for excellent service? If so, please provide a name if you know it.

Question Title

* 6. What else would you like to share regarding your experience.

Thank you for completing this survey!