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* 1. Please select the main service you received/contacted:

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* 2. Was the building clean?

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* 3. Was the staff friendly and helpful?

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* 4. I feel that I was provided service in a timely manner. (i.e. wait time):

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* 5. If needed, were special needs met during your visit?

  Yes No N/A
Handicap access
Visual assistance
Interpreter service
Hearing assistance

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* 6. Please indicate how much you agree or disagree with the following statements. Select only ONE answer per row.

  Strongly Agree Agree No Opinion Disagree Strongly Disagree
I am happy with my overall experience
I am satisfied with the service I received
I thought the printed materials were easy to understand
I thought the verbal instructions were easy to understand
I am likely to return to the Health Department for services
I am likely to recommend the Health Department to family and friends

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* 7. How likely is it that you would recommend Fargo Cass Public Health to a friend or colleague?

Not at all likely
Extremely likely

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* 8. Do you have any other comments, questions, or concerns?

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* 9. If you would like us to contact you about your experience at Fargo Cass Public Health, please provide your name and either a phone number or email address. 

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