YOUR FEEDBACK IS APPRECIATED

What Services did you receive? (More than one box may be checked)

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* 1. What Services did you receive? (More than one box may be checked)

Tell us about your experience.

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* 2. Tell us about your experience.

  Strongly Agree Agree Disagree Strongly Disagree N/A
I was treated with courtesy and respect
I felt the quality of service was excellent
My wait time today was acceptable
The person who helped me today was knowledgeable and competent
How did you hear about the Fairfield Department of Health's services? (Please check as many as needed)

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* 3. How did you hear about the Fairfield Department of Health's services? (Please check as many as needed)

Are the hours of operation(8:00 a.m. to 4:00 p.m. and closed from 11:30 to 12:00 for lunch) convenient for you?

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* 4. Are the hours of operation(8:00 a.m. to 4:00 p.m. and closed from 11:30 to 12:00 for lunch) convenient for you?

Do you feel that materials represent your race, language & ethnicity?

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* 5. Do you feel that materials represent your race, language & ethnicity?

Please provide the Fairfield Department of Health with any comments about your experience with us. Thank you.

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* 6. Please provide the Fairfield Department of Health with any comments about your experience with us. Thank you.

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