HOW WAS YOUR MOST RECENT EXPERIENCE WITH THE PORTAGE COUNTY HEALTH DISTRICT?

Customer satisfaction is important to us.
Please complete this brief survey to help us improve our services.
 
Thank you!

What date did you receive this service?

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* 1. What date did you receive this service?

Date / Time
What was the type of service(s) you received?  (Please check all that apply)

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* 2. What was the type of service(s) you received?  (Please check all that apply)

How did you find out about this service?

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* 3. How did you find out about this service?

Did you receive the service(s) and/or written material(s) in the language you wanted?

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* 4. Did you receive the service(s) and/or written material(s) in the language you wanted?

If No, please indicate the language you wanted:

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* 5. If No, please indicate the language you wanted:

If any educational materials were provided to you, were they helpful and able to be used as future references?

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* 6. If any educational materials were provided to you, were they helpful and able to be used as future references?

If you attended a training class taught by our staff, did the speaker keep your attention and allow for questions?

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* 7. If you attended a training class taught by our staff, did the speaker keep your attention and allow for questions?

Please rate the following:

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* 8. Please rate the following:

  Excellent Very Good Good Fair Poor Does not apply
Overall experience
Courtesy and professionalism of the service
Timeliness of the service
Value of the Portage County Health District and its services
Content and usability of the new PCHD website
Have you received service from the Portage County Health District in the past?

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* 9. Have you received service from the Portage County Health District in the past?

If you live outside of Portage County, please enter you city name:

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* 11. If you live outside of Portage County, please enter you city name:

Age:

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* 12. Age:

Gender:

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* 13. Gender:

Race/Ethnicity:

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* 14. Race/Ethnicity:

Do you feel your race/ethnicity, values/beliefs, or sexual orientation affected how you were treated?

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* 15. Do you feel your race/ethnicity, values/beliefs, or sexual orientation affected how you were treated?

If Yes, please explain:

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* 16. If Yes, please explain:

Please use this space to provide any additional comments or suggestions you may have about how we can improve our service:

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* 17. Please use this space to provide any additional comments or suggestions you may have about how we can improve our service:

THANK YOU!
For completing this survey and helping us to serve you better.
Please click the button below to submit.

Our Mission:  To promote public health, prevent disease, and protect the environment, utilizing leadership and partnership to empower individuals and communities to achieve optimal health.

Our Vision:  Healthy People.  Healthy Environments.  Healthy Communities.

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