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* 1. What information or service were you seeking from the Health Department? Check all that apply.

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* 2. Was the staff person(s) who helped you:

  Yes No
Prompt
Courteous
Positive
Knowledgeable
Helpful
Respectful

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* 3. How would you rate the overall service you received?

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* 4. Did you understand the information provided by staff?

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* 5. To help us provide the best possible customer service, please provide name the person(s) who assisted you.

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* 6. Do you have suggestions to improve service, additional services you would like, or other comments?

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* 7. If you would like to discuss your experience, please provide the following information:

Thank you for taking the time to complete this survey.

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