Health Department (Customer Satisfaction Survey) Customer Satisfaction Survey Question Title * 1. Agency you visited: Administration Adult Evaluation & Review Services (AERS) Adult Medical Day Services Birth & Death Certificates Clinic Developmental Disabilities Emergency Preparedness Environmental Health MA Transportation Maternal & Child Health Substance Use Recovery Wellness & Prevention WIC OK Question Title * 2. Please tell us when you visited the program Date Date OK Question Title * 3. Overall, how satisfied are you with the customer service you received? Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied OK Question Title * 4. Please rate our customer service on the following attributes: Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Friendly & Courteous Friendly & Courteous Very Satisfied Friendly & Courteous Satisfied Friendly & Courteous Neutral Friendly & Courteous Dissatisfied Friendly & Courteous Very Dissatisfied Timely & Responsive Timely & Responsive Very Satisfied Timely & Responsive Satisfied Timely & Responsive Neutral Timely & Responsive Dissatisfied Timely & Responsive Very Dissatisfied Accurate & Consistent Accurate & Consistent Very Satisfied Accurate & Consistent Satisfied Accurate & Consistent Neutral Accurate & Consistent Dissatisfied Accurate & Consistent Very Dissatisfied Accessible & Convenient Accessible & Convenient Very Satisfied Accessible & Convenient Satisfied Accessible & Convenient Neutral Accessible & Convenient Dissatisfied Accessible & Convenient Very Dissatisfied Truthful & Transparent Truthful & Transparent Very Satisfied Truthful & Transparent Satisfied Truthful & Transparent Neutral Truthful & Transparent Dissatisfied Truthful & Transparent Very Dissatisfied OK Question Title * 5. What was the reason for your visit? OK Question Title * 6. Suggestions or Comments about our service: OK Question Title * 7. Your feedback is anonymous. However, if you would like us to respond to your feedback, please leave your contact information below. Name Address City/Town State/Province ZIP/Postal Code Email Address Phone Number OK DONE