1.

* 1. Are you familiar with the services the health department provides?

* 2. Are the services the health department provides sufficient to meet the needs of our community?

* 3. Have you ever received any services from the health department?

* 4. Are the hours of operation (8:30-5:00 pm Monday-Friday except until 7:00 pm on Fridays) sufficient to meet the needs of the community?

* 5. Do you have any suggestions for improvement or additional services?

* 6. Other comments:

* 7. Name (optional)

T