DCHD Community Survey Question Title * 1. Please check any services you have ever received from DCHD. BCCCP/Adult Health Clinic Family Planning Clinic (Birth Control) Care Coordination 4 Children Child Health Clinic STD Clinic Health Education/Car Seats Public Health Preparedness TB Test or Form WIC School Nursing Immunizations Lab Work Only Pregnancy/OB Care Management Pregnancy Test Prenatal Clinic Restaurant/Hotel/Pool/Tattoo Artist Inspection or Permit Septic Records Request Question Title * 2. What other services would you like to see provided at DCHD? Question Title * 3. DCHD services are available from 8 am to 5 pm Monday through Friday. Are these hours convenient for you to obtain services from us? Yes No If no, what services and hours do you need available? Question Title * 4. The current top 3 health priorities for DCHD are:1) Preventing Obesity2) Stopping substance abuse/misuse3) Increasing access to healthcareDo you agree with these priorities? Yes No Explain Question Title * 5. Please share any ideas or suggestions for improving DCHD services. Question Title * 6. If you have a group that would like a presentation on services from DCHD, please provide your contact information: Name Phone # Topic Question Title * 7. If you would like to speak to a DCHD representative to contact you, please tell us how to contact you: Question Title * 8. OFFICE USE ONLYDate:Site: Done
