Cheyenne-Laramie County Health Department Customer Survey Question Title * 1. Please provide your ZIP code: Question Title * 2. Date of Service? Date Date Question Title * 3. Which division did you contact? Nursing Environmental Health Family Planning Public Health Response Coordinator Administration Question Title * 4. Briefly describe services provided Question Title * 5. Please rate our staff of the following, where A= Excellent and F= Poor. A B C D F Respectful Respectful A Respectful B Respectful C Respectful D Respectful F Knowledgeable Knowledgeable A Knowledgeable B Knowledgeable C Knowledgeable D Knowledgeable F Professional Professional A Professional B Professional C Professional D Professional F Friendly Friendly A Friendly B Friendly C Friendly D Friendly F Question Title * 6. How well did our staff do the following, where A = Excellent and F = Poor A B C D F Communicate information clearly Communicate information clearly A Communicate information clearly B Communicate information clearly C Communicate information clearly D Communicate information clearly F Listen to your concern Listen to your concern A Listen to your concern B Listen to your concern C Listen to your concern D Listen to your concern F Respond in a timely manner Respond in a timely manner A Respond in a timely manner B Respond in a timely manner C Respond in a timely manner D Respond in a timely manner F Question Title * 7. Please rate your overall experience with our department Excellent Good Fair Poor Question Title * 8. Please provide any additional comments, information, and/or suggestions. Done
