Vital Statistics Customer Satisfaction Survey

Question Title

* 1. Reason for visit

Birth Certificate

Death Certificate

Other (please specify)

Question Title

* 2. How knowledgeable do you feel PCPH Vital Statistics staff are?

Extremely

Very

Somewhat

Not so

Not at all

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* 3. How welcomed did you feel at PCPH?

Extremely

Very

Somewhat

Not so

Not at all

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* 4. Were you able to leave with what you needed today?

Yes

No

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* 5. Overall, how satisfied or dissatisfied are you with PCPH Vital Statistics?

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

Question Title

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