Allen County Public Health would like your feedback to make sure we are providing excellent service and care.  Please take a few minutes to complete this survey to help us improve.

When did you receive our services?

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* 1. When did you receive our services?

Date 
What was the MAIN service you received from us?

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* 2. What was the MAIN service you received from us?

Overall, I am pleased with the service I received.

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* 3. Overall, I am pleased with the service I received.

The staff treated me well.

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* 4. The staff treated me well.

I got the information or the service(s) that I needed.

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* 5. I got the information or the service(s) that I needed.

I was served in a timely manner (i.e. wait time).

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* 6. I was served in a timely manner (i.e. wait time).

The service or information was clear and easy to understand.

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* 7. The service or information was clear and easy to understand.

What changes, such as access through mobile devices or the computer, could make it easier to use our services?

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* 8. What changes, such as access through mobile devices or the computer, could make it easier to use our services?

What other suggestions do you have to help improve our services? Or other comments:

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* 9. What other suggestions do you have to help improve our services? Or other comments:

Thank you for taking our survey!
Optional:  If you would like to talk to someone at Allen County Public Health, you can call us at 419-228-4457, OR let us know how to contact you.

Please fill out your name and email/ phone ONLY if you want someone to contact you.

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* 10. Optional:  If you would like to talk to someone at Allen County Public Health, you can call us at 419-228-4457, OR let us know how to contact you.

Please fill out your name and email/ phone ONLY if you want someone to contact you.

For office use only.  Initial of clerk:

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* 11. For office use only.  Initial of clerk:

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