DCH--How is Our Customer Service?

1. We want to continue to improve....

...so we need your feedback. Please answer the following questions so we know how we are doing. If you see a question with an *, that means it has to be answered.

Question Title

* 1. I contacted DCH because I needed information on or from:
(Please choose all that apply.)

Medicaid or any of its programs

PeachCare for KidsTM

The State Health Benefit Plan (SHBP)

Health Planning

The Certificate of Need Program (CON)

Georgia Families

Fraud and Abuse

The Health Information Technology and Transparency Initiative (HITT)

The Office of Rural Health Services (ORHS)

The Office of Health Improvement (OHI)

Budget

The DCH Board

Grants and Requests for Proposal (RFPs)

Other

Other (please specify)

Question Title

* 2. If you contacted PeachCare for Kids TM, did you:

Call the 1-877-GAPEACH number

Contact someone at the Georgia Department of Community Health

Both

Question Title

* 3. Date of contact:

Date:

Date

Question Title

* 4. Type of contact:

Phone

E-mail

Internet

Question Title

* 5. I am a :

Member

Provider

Other

Other (please specify)

Question Title

* 6. Please rate the service you received today based on the following scale:
1 (Strongly Disagree) through 10 (Strongly Agree).

Please answer for each of the following statements:

	1	2	3	4	5	6	7	8	9	10
We were courteous	We were courteous 1	We were courteous 2	We were courteous 3	We were courteous 4	We were courteous 5	We were courteous 6	We were courteous 7	We were courteous 8	We were courteous 9	We were courteous 10
We were helpful	We were helpful 1	We were helpful 2	We were helpful 3	We were helpful 4	We were helpful 5	We were helpful 6	We were helpful 7	We were helpful 8	We were helpful 9	We were helpful 10
We were knowledgeable	We were knowledgeable 1	We were knowledgeable 2	We were knowledgeable 3	We were knowledgeable 4	We were knowledgeable 5	We were knowledgeable 6	We were knowledgeable 7	We were knowledgeable 8	We were knowledgeable 9	We were knowledgeable 10
We responded to you quickly	We responded to you quickly 1	We responded to you quickly 2	We responded to you quickly 3	We responded to you quickly 4	We responded to you quickly 5	We responded to you quickly 6	We responded to you quickly 7	We responded to you quickly 8	We responded to you quickly 9	We responded to you quickly 10
Even if we had to tell you "no," you were treated respectfully	Even if we had to tell you "no," you were treated respectfully 1	Even if we had to tell you "no," you were treated respectfully 2	Even if we had to tell you "no," you were treated respectfully 3	Even if we had to tell you "no," you were treated respectfully 4	Even if we had to tell you "no," you were treated respectfully 5	Even if we had to tell you "no," you were treated respectfully 6	Even if we had to tell you "no," you were treated respectfully 7	Even if we had to tell you "no," you were treated respectfully 8	Even if we had to tell you "no," you were treated respectfully 9	Even if we had to tell you "no," you were treated respectfully 10
Overall, I was satisfied with my contact with DCH	Overall, I was satisfied with my contact with DCH 1	Overall, I was satisfied with my contact with DCH 2	Overall, I was satisfied with my contact with DCH 3	Overall, I was satisfied with my contact with DCH 4	Overall, I was satisfied with my contact with DCH 5	Overall, I was satisfied with my contact with DCH 6	Overall, I was satisfied with my contact with DCH 7	Overall, I was satisfied with my contact with DCH 8	Overall, I was satisfied with my contact with DCH 9	Overall, I was satisfied with my contact with DCH 10

Question Title

* 7. Do you have a:

Question

Comment

Compliment

Complaint

Your input:

Question Title

* 8. If you would like us to contact you, please provide us with:

Your name

Phone number

E-mail address

Question Title

* 1. I contacted DCH because I needed information on or from:(Please choose all that apply.)

Question Title

* 2. If you contacted PeachCare for Kids TM, did you:

Question Title

* 3. Date of contact:

Question Title

* 4. Type of contact:

Question Title

* 5. I am a :

Question Title

* 6. Please rate the service you received today based on the following scale: 1 (Strongly Disagree) through 10 (Strongly Agree). Please answer for each of the following statements:

Question Title

* 7. Do you have a:

Question Title

* 8. If you would like us to contact you, please provide us with:

* 1. I contacted DCH because I needed information on or from:
(Please choose all that apply.)

* 6. Please rate the service you received today based on the following scale:
1 (Strongly Disagree) through 10 (Strongly Agree).

Please answer for each of the following statements: