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

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* 2. Would you like to list the name of the staff you worked with?

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* 3. Was the building clean?

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* 4. Were you greeted when you entered the building?

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* 5. Was the staff friendly and helpful?

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* 6. I feel that my questions and/or concerns were addressed in a timely manner:

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

  Yes No I did not have any special needs
Handicap access
Visual assistance
Interpreter service
Hearing assistance

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* 8. 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
Online materials were current and easy to understand
I am likely to return to the Health Department for services

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* 9. Outside of the Division you visited today, are you aware of other programs Fargo Cass Public Health offers?

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

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* 12. 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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