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Please click DONE when finished to submit your responses. Thank you for taking time to help us better serve you!

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* 1. In which Zip Code do you live?

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* 3. What service(s) did you receive on that date from the Allegany County Health Department?

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* 4. How do you feel about the following:

  Strongly Disagree Disagree Unsure Agree Strongly Agree
I was treated with respect and kindness
I was satisfied with the quality of services I received
I feel that my needs have been met
My wait time was acceptable
The person who assisted me seemed knowledgeable

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* 5. Did someone go above and beyond to assist you? Let us know.

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* 6. What could we have done better? Additional Comments:

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* 7. What is your overall rating of Allegany County Health Department

OPTIONAL Information

You do not have to provide this information. You will not be asked for your name or any identifying information. However, answering these questions will help us improve our services. Thank you for taking the time to complete this questionnaire.

(Please click DONE at the bottom)

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* 8. What is your racial and ethnic identity?

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* 9. What is your age ?

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* 10. What is your gender?

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* 11. Household Income

Your feedback is anonymous. However, if you would like to contact us feel free to do so at: ACHD.planning@maryland.gov or by calling (301) 759-5000
Thank you for taking time to help us better serve you!

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