Instructions for Completing the Survey:

Please select the best answer and click "done" at the bottom of the page when finished. The following questions (1-3) ask for basic demographic information.  Your answers to these questions will not affect the services you receive in any way.

* 1. I identify my gender as…

* 2. What is your current age?

* 3. I identify my race as

* 4. During your most recent visit with the McDonough County Health Department, what program(s)/ service(s) did you receive? (please check all that apply)

* 5. What programs would you utilize if they were offered at the health department?

* 6. Select how you most prefer learning about our available services and programs. Please choose only one option.

* 7. In your opinion does the McDonough County Health Department meet your needs or the needs of the community?

* 8. Have you received services from the McDonough County Health Department in the last 6 months?

* 9. The McDonough County Health Department staff was helpful, friendly, and respectful

* 10. The service(s) I received were delivered promptly.

* 11. The services I received met my social, cultural, and/or special needs.

* 12. The office hours met my needs.

* 13. I would recommend the McDonough County Health Department to my friends and family.

* 14. Did the McDonough County Health Department staff give you information during your visit about other services for which you might be eligible?

* 15. Overall, I am satisfied with the service(s) I received

* 16. Did anyone provide outstanding service? If so, whom?

* 17. Do you have any additional comments? (Please be specific.)