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* 1. Are you familiar with the services the Health Department provides?

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* 2. Have you ever received any services from the Health Department?

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* 3. How did you hear about our services?

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* 4. Do the following Health Department services meet the needs of our community?

  Yes No No Opinion
Adult Health (Physical/Wellness)
Care Coordination for Children (CC4C)
Communicable Disease (TB, Rabies, etc.)
Employee Health
Food/Lodging Inspection
Health Promotion and Education
Family Planning (Birth Control)
Immunizations
School Health Assessments
Laboratory Services
Maternity Clinic
Obstertic (Pregnancy) Care Management (OBCM)
Septic System Permits
Sexually Transmitted Diseases (STD) Clinic
Sports Physicals
Well/Water Permits
Well/Water Sampling
WIC (Women, Infant and Children)
Home Health

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* 5. Are there any additional services that the Health Department could offer to better meet the needs of our community?

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* 6. The health department is open 8am-5pm. Are these hours of operation sufficient to meet the needs of our community?

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

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* 8. The health department acknowledges that travel is difficult in Franklin County. The location of the Health Department is in Louisburg, NC. What other communities in our country do you think could benefit from a satellite location?

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* 9. Additional Comments:

T