The purpose of this survey is intended to find out how often county residents utilize the Franklin County
Health Department's services and to help us improve when, how, and what services we offer. You do not need to put your name on this survey.

* 1. Please check the area(s) in which you received service:

* 2. Which of the following best describes your racial or ethnic background?

* 3. What is your age?

* 4. What are some things that would make you more likely to visit the Franklin County Health Department?

* 5. Thinking of your visit, how would you rate the following? (Fill in only one box for each item)

  Poor Fair Good Excellent
Privacy provided
Length of wait time
Quality of care provided
Cleanliness of Health Department
Bulletin Board/Educational Displays
Directional Signs in the Building