* 1. Please check any services you have ever received from DCHD.

* 2. What other services would you like to see provided at DCHD?

* 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?

* 4. The current top 3 health priorities for DCHD are:
1) Preventing Obesity
2) Stopping substance abuse/misuse
3) Increasing access to healthcare

Do you agree with these priorities?

* 5. Please share any ideas or suggestions for improving DCHD services.

* 6. If you have a group that would like a presentation on services from DCHD, please provide your contact information:

* 7. If you would like to speak to a DCHD representative to contact you, please tell us how to contact you:

* 8. OFFICE USE ONLY
Date:
Site:

T