Date of Service (if you know it)

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

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

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

Health Department Building

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* 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?
Service

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* 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?
Employees/Staff

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

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

What can we improve?

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* 7. What can we improve?

How did you hear about us?

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* 8. How did you hear about us?

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