Community Satisfaction Survey

Please select the best answer for each question. Questions 1-3 ask for basic demographic information. Your answers to these questions will not affect the services you receive in any way. All survey responses are anonymous. 

Question Title

* 1. I identify my gender as:

Question Title

* 2. What is your current age?

Question Title

* 3. Where do you reside in the county? (Select the area that best describes your distance of travel to the health department)

Question Title

* 4. What is your race or ethnicity?

Question Title

* 5. During your most recent visit with McDonough County Health Department, what program(s)/service(s) did you receive? (Choose all that apply)

Question Title

* 6. What programs would you utilize if they were offered at the health department? For example: dental services, diaper bank, etc.)

Question Title

* 7. Select how you most prefer learning about our available services and programs. Please choose only one option. 

Question Title

* 8. In your opinion the McDonough County Health Department meets your needs and/or the needs of the community.

Question Title

* 9. Have you received services from the McDonough County Health Department in the last 6 months?

Question Title

* 10. If YES, please continue to the next questions. If NO, please skip to question 18.


Health Department Staff was helpful, friendly, and respectful.

Question Title

* 11. The services I received were delivered promptly.

Question Title

* 12. The services I received met my social, cultural, and/or special needs. 

Question Title

* 13. The office hours met my needs. 

Question Title

* 14. I would recommend the McDonough County Health Department to my friends and family.

Question Title

* 15. Health department staff gave me information during my visit about other services for which I might be eligible? 

Question Title

* 16. Overall, I am satisfied with the services I received.

Question Title

* 17. Did anyone provide outstanding service? If so, whom?

Question Title

* 18. Do you have any additional comments? (Please be specific.)

T