Question Title

* 1. Date of Service (if you know it)

Date / Time

Question Title

* 2. Program(s) Visited: If you visited more than one program, please click all that apply.

Question Title

* 3. Health Department Building

  Yes No Not Applicable
Was the building easy to find?
Was the office clean?
Were there parking spaces available?
If assistance was needed upon entering the building, did you receive it?
If you phones, was the phone system easy to use?

Question Title

* 4. Service

  Yes No Not Applicable
Was the you needed easy to find in the building?
Was the waiting room comfortable?
Was your waiting time appropriate?
Did the office hours meet your needs?
Did the service/program meet your needs?

Question Title

* 5. Employees/Staff

  Yes No Not Applicable
Were staff knowledgeable about programs/services?
Did staff have professional attitudes?
Did staff have professional appearance?
Were staff friendly/polite?
Were staff helpful?
Were staff punctual/on time?

Question Title

* 6. We value your comments.  Please tell us more about your visit.  What did we do well?

Question Title

* 7. What can we improve?

Question Title

* 8. How did you hear about us?

T