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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