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.

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* 1. Date of Service

Date / Time

Date

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* 2. The main service I received was:

Clinical/Nursing

Vital Statistics

Other (please specify)

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* 3. I learned about these services through (mark all that apply):

Friend/Family Member/Current client

Facebook or Health Department Website

Other (please specify)

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* 4. Please rate your experience:

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Not Applicable
I was able to get an appointment date and time in a timely manner	I was able to get an appointment date and time in a timely manner Strongly Agree	I was able to get an appointment date and time in a timely manner Agree	I was able to get an appointment date and time in a timely manner Neutral	I was able to get an appointment date and time in a timely manner Disagree	I was able to get an appointment date and time in a timely manner Strongly Disagree	I was able to get an appointment date and time in a timely manner Not Applicable
My wait time was acceptable	My wait time was acceptable Strongly Agree	My wait time was acceptable Agree	My wait time was acceptable Neutral	My wait time was acceptable Disagree	My wait time was acceptable Strongly Disagree	My wait time was acceptable Not Applicable
The staff were courteous	The staff were courteous Strongly Agree	The staff were courteous Agree	The staff were courteous Neutral	The staff were courteous Disagree	The staff were courteous Strongly Disagree	The staff were courteous Not Applicable
The staff clearly explained the service and verbal instructions were easy to understand	The staff clearly explained the service and verbal instructions were easy to understand Strongly Agree	The staff clearly explained the service and verbal instructions were easy to understand Agree	The staff clearly explained the service and verbal instructions were easy to understand Neutral	The staff clearly explained the service and verbal instructions were easy to understand Disagree	The staff clearly explained the service and verbal instructions were easy to understand Strongly Disagree	The staff clearly explained the service and verbal instructions were easy to understand Not Applicable
I am satisfied with my overall experience	I am satisfied with my overall experience Strongly Agree	I am satisfied with my overall experience Agree	I am satisfied with my overall experience Neutral	I am satisfied with my overall experience Disagree	I am satisfied with my overall experience Strongly Disagree	I am satisfied with my overall experience Not Applicable
My questions were answered	My questions were answered Strongly Agree	My questions were answered Agree	My questions were answered Neutral	My questions were answered Disagree	My questions were answered Strongly Disagree	My questions were answered Not Applicable

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* 5. Please describe your experience if noted Disagree or Strongly Disagree above.

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* 6. What is the most important thing that we can do to improve our services?

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* 7. Is there anyone you would like to recognize for excellent service? If so, please provide a name if you know it

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* 8. Would you recommend us to your friends/family?

Yes

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* 9. What is your preferred method of communication with the health department?

Phone Call

Text Message

Other (please specify)

Thank you for completing this survey!