Skip to content
Alliance City Health Department Satisfaction Survey
*
1.
Overall, how satisfied were you with the services you received at the health department?
(Required.)
Very satisfied
Satisfied
Somewhat dissatisfied
Very Dissatisfied
*
2.
How likely are you to recommend the health department and the services provided?
(Required.)
Very likely
Likely
Somewhat unlikely
Very unlikely
*
3.
Which of the following reflects the reason for your visit with the Health Department?
(Required.)
WIC
Immunizations
Birth/Death Records
Environmental Health (i.e., food service, nuisances, housing)
STD/HIV Clinic
Other (please specify)
*
4.
Is there anyone you specifically interacted with that you would like to recognize?
(Required.)
*
5.
If you have any additional comments, suggestions or complaints, please briefly explain below:
(Required.)