Customer Satisfaction Survey City of Middletown Ohio Public Health Department We appreciate your feedback on your experience with our Health Department and/or Environmental Services. OK Question Title * 1. Overall, how would you rate the quality of your customer service experience? Very positive Somewhat positive Neutral Somewhat negative Very negative OK Question Title * 2. How likely is it that you would recommend Health Department to a friend or colleague? NOT AT ALL LIKELY EXTREMELY LIKELY 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 OK Question Title * 3. Are our hours of operation sufficient to meet your needs? Yes No OK Question Title * 4. The wait time for service was reasonable. Yes No OK Question Title * 5. The staff was friendly and courteous. Yes No OK Question Title * 6. What type of service did you receive today? Campground Sewage Food Service Pools/Spas Rabies Birth Certificate Death Certificate Burial Permit Notary Health Commissioner Request HIV Testing/ Covid Testing Syringe Exchange Vaccination Nursing Services and/or Consult Medical Services and/or Medical Consult Environmental Consult (Restaurant/Food Service/Safety) Other (please specify) OK Question Title * 7. Date of service. Date / Time Date OK Question Title * 8. Please leave your contact information if you would like to discuss your experience. Name Company Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number OK DONE
