Thank you for taking the time to fill out this survey. We appreciate your feedback. The information you share will be used to help the Boston Public Health Commission improve the quality of its services. If you have questions  please contact us at info@bphc.org. For more information about our programs and services please visit our website at www.bphc.org. 

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* 1. Date of most recent service

Date

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* 2. What service did you most recently receive? (check one)

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* 3. Please give details about the type of service you said you received in question number two? 

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* 4. Where did you receive this service? (check one)

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* 5. How satisfied were you with this service? (check one)

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* 6. If you were not satisfied, please share 1- 2 things that can be improved. (Optional)

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* 7. If you were satisfied, please tell us 1 or 2 things that you felt we did well. (Optional)

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* 8. Would you recommend the service you received to another member of the community? (check one)

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* 9. What's your current zip code? 

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