* 1. Today I:

* 2. Reason for visit:

* 3. Please rate us on the following:

  Great Good Fair Poor
Wait Time
Total Visit Time
Friendliness of Staff
Treated with dignity by Staff
Treated with respect by Staff & Providers
Privacy
Overall Service

* 4. At your visit today, did you get all of your questions answered?

* 5. Did Health Department staff explain things in a way that was easy for you to understand?

* 6. The Health Department is open Monday-Friday, 8AM-5PM.  Are these hours of operation sufficient to meet your needs?

* 7. If no, please check the hours that would meet your needs.  Check all that apply.

* 8. In October 2016, the Health Department started calling patients instead of mailing letters to remind patients of appointments.  Do you have any feedback on this change in operations?

* 9. In January 2017, the Health Department began closing from 8:30AM-9:30AM on the first Tuesday of the month for a Monthly Staff Meeting.  Do you have any feedback on this change in operations?

* 10. The Health Department acknowledges that travel is difficult in Jackson County.  The main location of the Health Department is in Sylva, NC with a satellite in Cashiers, NC.  What other communities in our county could benefit from satellite Health Department locations?

* 11. Would you be in support of a mobile clinic that could travel to various communities in Jackson County, offering Health Department services?

* 12. Would you like to share any other information with us?

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