1.What was your main purpose for visiting the health department today?

Immunizations

Plumbing permit

Food permit

Birth/death certificate

Other

2.Were all of your questions answered during your visit?

Yes

No

3.Were you satisfied with the assistance you received?

Yes

No

4.If you responded “No” to question #3, may we contact you for more information?

5.Is there someone specific who assisted you at the health department?

6.Do you have any feedback on how we can serve you better?