We value you as a customer deserving the best service we can offer. Please tell us how we are doing by answering the following questions about the services you received today. Thank you.

* 1. Date of your Visit?

Date
/
/

* 2. Did you have an appointment?

* 3. What service did you receive today?

* 4. How helpful and courteous was our staff?

* 5. Did staff have the skills/knowledge to meet your needs?

* 6. How long were you here for your visit?

* 7. How acceptable was the length of your visit to you?

* 8. How well do the hours we provide services meet your needs?

* 9. Did you have any concerns about the privacy of your medical information?

* 10. Would you refer family or friends to Davidson County Health Department?

* 11. Comments (Please share any ideas or suggestions for improving our services.)

* 12. Would you like someone to call you about the services you received today?

Thanks for your feedback! If you would like to discuss anything about your visit in further detail, please contact our Quality Improvement Coordinator at 336-242-2344 or by email at nancy.stout@davidsoncountync.gov

T