In order for the Douglas County Health Department to best serve you, please take a few minutes to share your opinion with us.  The survey should take about 5 minutes.
Thank you! 

Date of Service or Visit to Douglas County Health Department (DCHD)

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* 1. Date of Service or Visit to Douglas County Health Department (DCHD)

Date of Service or Visit
Your Zip Code

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* 2. Your Zip Code

What is your gender?

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* 3. What is your gender?

What is your age?

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* 4. What is your age?

What is your race/ethnicity?

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* 5. What is your race/ethnicity?

Select the option that best describes the quality of service you received for each of the items listed below.

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* 6. Select the option that best describes the quality of service you received for each of the items listed below.

  Excellent Good Fair Poor Does Not Apply
Courtesy and helpfulness of staff
Staff were very knowledgeable about the services requested
Staff listened to my concerns and were able to answer questions to my satisfaction
Overall quality of staff assistance
Overall quality of service(s) received
Which service did you receive from Douglas County Health Department?

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* 7. Which service did you receive from Douglas County Health Department?

T