DOH-Brevard Website Satisfaction Survey

Thank you for recently using services with the Florida Department of Health in Brevard County (DOH-Brevard)! Please complete this short, anonymous survey to share your feedback on how we did and how we can continue to improve our services. Please do not enter confidential or identifiable information in this survey as it is not a secured communication. If you would like to speak to someone about the service you received, please call 321-454-7111 or email us at Brevard.Feedback@FLHealth.gov. We value your opinion of our services and appreciate your input.

Question Title

* 1. What was the date of service?

Date

Question Title

* 2. Where did you receive services or information?

Community Health

Environmental Health

Melbourne Clinic

Melbourne WIC

Titusville Clinic

Titusville Dental

Titusville WIC

Viera Administration

Viera Clinic

Viera Dental

Viera WIC

Vital Statistics

Question Title

* 3. I was satisfied with:


The quality of products, services, and information	The quality of products, services, and information	The quality of products, services, and information	The quality of products, services, and information
The employees who provides the products, services, and information	The employees who provides the products, services, and information	The employees who provides the products, services, and information	The employees who provides the products, services, and information
The timeliness of products, services, and information	The timeliness of products, services, and information	The timeliness of products, services, and information	The timeliness of products, services, and information
Overall, I was satisfied with the service I received	Overall, I was satisfied with the service I received	Overall, I was satisfied with the service I received	Overall, I was satisfied with the service I received

DOH-Brevard Website Satisfaction Survey

Question Title

* 1. What was the date of service?

Question Title

* 2. Where did you receive services or information?

Question Title

* 3. I was satisfied with:

Question Title

* 4. Please provide any additional feedback for our staff.
Include the names of any staff member who assisted you or any issues you encountered.

Question Title

* 5. Optional: If you would like to be contacted about your answers, please provide your name, email and/or phone number.

DOH-Brevard Website Satisfaction Survey

Question Title

* 1. What was the date of service?

Question Title

* 2. Where did you receive services or information?

Question Title

* 3. I was satisfied with:

Question Title

* 4. Please provide any additional feedback for our staff. Include the names of any staff member who assisted you or any issues you encountered.

Question Title

* 5. Optional: If you would like to be contacted about your answers, please provide your name, email and/or phone number.

* 4. Please provide any additional feedback for our staff.
Include the names of any staff member who assisted you or any issues you encountered.