CHD Customer Satisfaction Survey Please rate the following regarding your service from Champaign Health District: Question Title * 1. Courtesy of staff Poor Fair OK Good Great N/A Poor Fair OK Good Great N/A OK Question Title * 2. Provided clear information Poor Fair OK Good Great N/A Poor Fair OK Good Great N/A OK Question Title * 3. Convenience of hours Poor Fair OK Good Great N/A Poor Fair OK Good Great N/A OK Question Title * 4. Wait time Poor Fair OK Good Great N/A Poor Fair OK Good Great N/A OK Question Title * 5. Overall service Poor Fair OK Good Great N/A Poor Fair OK Good Great N/A OK Question Title * 6. Please let us know if you have any suggestions/ comments. OK Question Title * 7. What day did you visit the health district? Date / Time Date OK Question Title * 8. If your interaction was with a specific employee, please enter their name here. OK Question Title * 9. What division did you visit? Vital Statistics Environmental Services Community Health Services OK DONE