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1. Which location did you receive services at?

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2. Which services did you receive from Cochise County Health & Social Services

Who did you interact with? Please choose the individual(s) at the location you visited below.

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3. Benson

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4. Bisbee

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5. Douglas

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6. Sierra Vista

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7. Willcox

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8. Cochise County Health & Social Services staff were knowledgeable.

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9. Cochise County Health & Social Services staff answered all my questions and concerns to my satisfaction.

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10. Cochise County Health & Social Services staff provided services in a courteous and professional manner.

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11. Cochise County Health & Social Services staff responded to my inquiries in a timely manner.

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12. Overall, I am very satisfied with the Cochise County Health & Social Services staff.

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13. What was the date of your service?

Date

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14. Any other comments or suggestions you wish to share?

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15. Would you like to be contacted by a member of the Cochise County Health & Social Services Leadership Team?

T