DHD #10 Customer Satisfaction Survey

We want to hear from you! District Health Department #10 strives to provide great customer service and to make sure that we meet the needs of our communities. Thanks for taking the time to help us improve.

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* 1. Would you be willing to take a quick survey to let us know how we're doing?

Yes

No - Client Declined

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* 2. What service did you receive?

Breast and Cervical Cancer Screening Program

Children Special Health Care Services

Family Planning

Food Service or Safety

Immunizations

Medicaid Application Assistance

MIHP (Material Infant Health Program)

STD/HIV Services

Well or Septic Permit

WIC (Women, Infants, and Children)

WISEWOMAN

Other Service (please specify)

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* 3. Where did you receive your service?

Crawford (Grayling)

Kalkaska

Lake (Baldwin)

Manistee

Mason (Ludington)

Mecosta (Big Rapids)

Missaukee (Lake City)

Newaygo (White Cloud - Main Office)

Newaygo (Grant)

Oceana (Hart - Main Office)

Oceana (Shelby)

Wexford (Cadillac)

Other (please specify)

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* 4. Please take a moment to rate us on the categories below

	Very Poor	Poor	Fair	Good	Very Good	Does Not Apply
Ability to get an appointment.	Ability to get an appointment. Very Poor	Ability to get an appointment. Poor	Ability to get an appointment. Fair	Ability to get an appointment. Good	Ability to get an appointment. Very Good	Ability to get an appointment. Does Not Apply
Hours service is available.	Hours service is available. Very Poor	Hours service is available. Poor	Hours service is available. Fair	Hours service is available. Good	Hours service is available. Very Good	Hours service is available. Does Not Apply
Time in waiting room.	Time in waiting room. Very Poor	Time in waiting room. Poor	Time in waiting room. Fair	Time in waiting room. Good	Time in waiting room. Very Good	Time in waiting room. Does Not Apply
Staff listened to you.	Staff listened to you. Very Poor	Staff listened to you. Poor	Staff listened to you. Fair	Staff listened to you. Good	Staff listened to you. Very Good	Staff listened to you. Does Not Apply
Staff took enough time with you.	Staff took enough time with you. Very Poor	Staff took enough time with you. Poor	Staff took enough time with you. Fair	Staff took enough time with you. Good	Staff took enough time with you. Very Good	Staff took enough time with you. Does Not Apply
Staff returned your call promptly.	Staff returned your call promptly. Very Poor	Staff returned your call promptly. Poor	Staff returned your call promptly. Fair	Staff returned your call promptly. Good	Staff returned your call promptly. Very Good	Staff returned your call promptly. Does Not Apply
Staff was respectful to you.	Staff was respectful to you. Very Poor	Staff was respectful to you. Poor	Staff was respectful to you. Fair	Staff was respectful to you. Good	Staff was respectful to you. Very Good	Staff was respectful to you. Does Not Apply
Staff answered your questions.	Staff answered your questions. Very Poor	Staff answered your questions. Poor	Staff answered your questions. Fair	Staff answered your questions. Good	Staff answered your questions. Very Good	Staff answered your questions. Does Not Apply
Overall quality of service.	Overall quality of service. Very Poor	Overall quality of service. Poor	Overall quality of service. Fair	Overall quality of service. Good	Overall quality of service. Very Good	Overall quality of service. Does Not Apply

DHD #10 Customer Satisfaction Survey

Question Title

* 1. Would you be willing to take a quick survey to let us know how we're doing?

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* 2. What service did you receive?

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* 3. Where did you receive your service?

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* 4. Please take a moment to rate us on the categories below

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* 5. Additional Comments

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* 6. Would you like us to contact you?