English Español Français Português English Customer Complaint Survey We take customer feedback very seriously, and while we do not want our customers to have a less than satisfactory visit, we value your feedback. Please complete the following survey to tell us more about your recent visit. All items below are optional, however the more you tell us the better we can work to resolve the issue. Question Title * 1. Date that the problem or issues occurred. . Question Title * 2. With which department or clinic did you have the problem or issue? Area 7 Bellies, Babies and Beyond Phone Call/Call Center Chronic Disease Dental Environmental Public Health / Environmental Water Lab Epidemiology Family Planning and Prenatal Health Front Desk Immunizations Medical Records NCF School Health Sexually Transmitted Disease Sunshine Care Center Tuberculosis Services Violence & Injury Prevention Vital Statistics WIC Other (please specify) Question Title * 3. What was the location? Apopka - 1111 North Rock Springs Road Central - 832 West Central Boulevard Central - Vital Statistics - 807 West Chruch Street Central - Medical Records - 807 West Chruch Street Executive Center - 1001 Executive Center Drive Hoffner – WIC - 5449 South Semoran Boulevard Hoffner Dental - 5449 South Semoran Boulevard Lake Ellenor (Southside) - 6101 Lake Ellenor Drive Lila Mitchell - Temporarily Closed - 5151 Raleigh Street Mobile – Dental NCF Bithlo - 18510 Madison Avenue NCF Englewood - 5985 La Costa Drive NCF Pine Hills - 2804 Belco Drive NCF Taft - 9500 South Orange Avenue NCF Union Park - 9645 East Colonial Drive Ocoee - 475 Story Road Winter Garden - 13275 West Colonial Drive Other (please specify) Question Title * 4. Complaint: Billing issues Difficulty reaching someone by phone Failure to provide timely responses to requests for information Lack of appointments Lack of knowledge Lack of personal attention Long wait times Poor follow-ups Poor response to inquiries Rude staff Slow service Unclear communication Unclear or confusing application processes Unhelpful staff Unprofessional or unfriendly staff Question Title * 5. Please tell us more about the issue or problem. Question Title * 6. Provide us with your contact information so we can talk to you about the problem or issue.Please note that we cannot email you about the issue/problem due to security requirements. Name - first and last Phone number Done
