Cheyenne-Laramie County Health Department Customer Survey

* 1. Please provide your ZIP code:

* 2. Date of Service?

Date
/
/

* 3. Which division did you contact?

* 4. Briefly describe services provided

* 5. Please rate our staff of the following, where A= Excellent and F= Poor.

  A B C D F
Respectful
Knowledgeable
Professional
Friendly

* 6. How well did our staff do the following, where A = Excellent and F = Poor

  A B C D F
Communicate information clearly
Listen to your concern
Respond in a timely manner

* 7. Please rate your overall experience with our department

* 8. Please provide any additional comments, information, and/or suggestions.

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