SurveyMonkey Powered Online Survey

Customer Satisfaction Survey

Thank you for choosing Chisago County Public Health. In order to continuously improve the services we provide, we kindly ask that you complete the following survey. The survey will only take a few minutes of your time. The responses you provide will be confidential. No identifying information about you will be collected.

We thank you in advance for your valuable feedback.

Question Title

1. What was the date of your most recent visit with Chisago County Public Health programs/services?

Date

Question Title

2. During your most recent encounter with Chisago County Public health, what program(s)/service(s) did you receive? (please check all that apply)

Dental Health Visit

WIC Appointment

Child or Adolescent Immunization

Adult Immunization

Car Seat Class/Inspection

Maternal and Child Health (Family Home Visit)

Baby Cafe (Breastfeeding Support Group)

Child and Teen Check-Up (Outreach Phone Call)

Statewide Health Improvement Partnership (Mini-Grant)

Other (please specify)

Question Title

3. Where did you learn about our available programs and services?

From friend or family

Health Department staff member

Brochure or flyer

Newspaper

Facebook

Chisago County Website

Referral (Doctor, hospital, other agency)

Walk-in

Other (please specify)

Question Title

4. In the future, how would you like to learn about Chisago County Public Health programs and services? (Please check all that apply)

Chisago County Website

Community Events

Facebook

Radio

Direct Mail

Text Message

Other (please specify)

Question Title

5. Please indicate what best describes each of the following statements:

	Strongly Disagree	Disagree	Agree	Strongly Agree	Not Applicable
Health Department staff were friendly	Health Department staff were friendly Strongly Disagree	Health Department staff were friendly Disagree	Health Department staff were friendly Agree	Health Department staff were friendly Strongly Agree	Health Department staff were friendly Not Applicable
The services I received were delivered promptly	The services I received were delivered promptly Strongly Disagree	The services I received were delivered promptly Disagree	The services I received were delivered promptly Agree	The services I received were delivered promptly Strongly Agree	The services I received were delivered promptly Not Applicable
Health Department staff were respectful	Health Department staff were respectful Strongly Disagree	Health Department staff were respectful Disagree	Health Department staff were respectful Agree	Health Department staff were respectful Strongly Agree	Health Department staff were respectful Not Applicable
The building was clean and welcoming	The building was clean and welcoming Strongly Disagree	The building was clean and welcoming Disagree	The building was clean and welcoming Agree	The building was clean and welcoming Strongly Agree	The building was clean and welcoming Not Applicable
The wait time for the services I received was appropriate	The wait time for the services I received was appropriate Strongly Disagree	The wait time for the services I received was appropriate Disagree	The wait time for the services I received was appropriate Agree	The wait time for the services I received was appropriate Strongly Agree	The wait time for the services I received was appropriate Not Applicable
Health Department staff were helpful	Health Department staff were helpful Strongly Disagree	Health Department staff were helpful Disagree	Health Department staff were helpful Agree	Health Department staff were helpful Strongly Agree	Health Department staff were helpful Not Applicable
The services I received met my social, cultural, and/or special needs	The services I received met my social, cultural, and/or special needs Strongly Disagree	The services I received met my social, cultural, and/or special needs Disagree	The services I received met my social, cultural, and/or special needs Agree	The services I received met my social, cultural, and/or special needs Strongly Agree	The services I received met my social, cultural, and/or special needs Not Applicable
Health Department staff took the time to listen to my concerns	Health Department staff took the time to listen to my concerns Strongly Disagree	Health Department staff took the time to listen to my concerns Disagree	Health Department staff took the time to listen to my concerns Agree	Health Department staff took the time to listen to my concerns Strongly Agree	Health Department staff took the time to listen to my concerns Not Applicable
Health Department staff understood my needs	Health Department staff understood my needs Strongly Disagree	Health Department staff understood my needs Disagree	Health Department staff understood my needs Agree	Health Department staff understood my needs Strongly Agree	Health Department staff understood my needs Not Applicable
Overall, I am satisfied with services I received	Overall, I am satisfied with services I received Strongly Disagree	Overall, I am satisfied with services I received Disagree	Overall, I am satisfied with services I received Agree	Overall, I am satisfied with services I received Strongly Agree	Overall, I am satisfied with services I received Not Applicable
I was able to get what I needed from Chisago County Public health	I was able to get what I needed from Chisago County Public health Strongly Disagree	I was able to get what I needed from Chisago County Public health Disagree	I was able to get what I needed from Chisago County Public health Agree	I was able to get what I needed from Chisago County Public health Strongly Agree	I was able to get what I needed from Chisago County Public health Not Applicable

Question Title

6. What did we do well during your most recent visit?

Question Title

7. What can we improve? (Please be as specific as you can.)

The following questions ask for basic demographic information. Your answers to these questions will not affect the services you receive in any way.

Question Title

8. What is your gender?

Question Title

9. What is your current age?

18-24 years old

25-39 years old

40-64 years old

65 years old or older

Question Title

10. How do you identify yourself?

White, Non-Hispanic

Black or African American

Hispanic or Latino

American Indian or Alaskan Native

Asian

Native Hawaiian or Other pacific Islander

Other (please specify)

Question Title

11. What is the highest level of education you have completed?

Less than High School

High School graduate

Some College; Technical or Vocational Education

Associate's Degree

Bachelor's Degree

Graduate or Professional Degree

Question Title

1. What was the date of your most recent visit with Chisago County Public Health programs/services?

Question Title

2. During your most recent encounter with Chisago County Public health, what program(s)/service(s) did you receive? (please check all that apply)

Question Title

3. Where did you learn about our available programs and services?

Question Title

4. In the future, how would you like to learn about Chisago County Public Health programs and services? (Please check all that apply)

Question Title

5. Please indicate what best describes each of the following statements:

Question Title

6. What did we do well during your most recent visit?

Question Title

7. What can we improve? (Please be as specific as you can.)

Question Title

8. What is your gender?

Question Title

9. What is your current age?

Question Title

10. How do you identify yourself?

Question Title

11. What is the highest level of education you have completed?

Question Title

12. Additional Comments