Customer Satisfaction Survey

Dear Client,

Thank you for giving us the opportunity to serve you better. Please help us by taking a few minutes to tell us about the quality of the service that you have received. We appreciate your business and want to make sure we meet your expectations.

Sincerely,

Sara Jo Best

Public Health Department Director

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* 1. What day did you contact or visit one of the Lincoln Trail District Health Department sites?

Date / Time

Date

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* 2. Which department did you have contact with? Please click all that apply.

Clinic (WIC, immunizations, STD testing or treatment, TB services, Medical Nutrition Therapy, Harm Reduction Syringe Service Program, Vital Statistics)

Administrative (Finance, Accreditation, Contracts)

Community Health Education (Classes, Program, Coalition, Events, etc.)

Environmental (Food establishment inspection, onsite septic system permit/inspection, Person In Charge training, nuisance complaints, pool inspection, facility inspections (schools, hotels, motels, summer camps, mobile home parks, etc.)

HANDS (Initial/exit assessments, quarterly visit by nurse or social worker, family support visit, or graduation)

Epidemiology (Communicable disease surveillance or investigation or Epi Rapid Response Team)

Emergency Preparedness

Human Resources

Other (please describe the services you received)

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* 3. If you called to schedule an appointment or speak with an employee, was the person who helped you friendly, knowledgeable and helpful?

Yes

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* 4. If you visited one of our offices, were you greeted with a smile and in a friendly manner upon entering our office?

Yes

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* 5. If you had an appointment for a service, how long did you wait before you were called back to meet with our staff?

Less than 10 minutes

10-20 minutes

20-30 minutes

More than 30 minutes

Not applicable

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* 6. During your recent visit, did you receive...(check all that apply)

Education on an area of need

Education not on an area of need

Answers to your questions

Referral to appropriate resources in the community

No education or referral received

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* 7. How satisfied or dissatisfied were you with the service you received from Lincoln Trail District Health Department?

Very satisfied

Satisfied

Neither satisfied nor dissatisfied

Dissatisfied

Very dissatisfied

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* 8. What office did you visit?

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* 9. From the time you walked in, to the time you left, was your visit handled in a confidential manner?

Yes

If no, please tell us how we could have done a better job:

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* 10. Please let us know about anything else that may help us provide quality services.

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* 11. While not required, you are encouraged to leave your name and contact information. In doing so, you will aid administration in the investigation of any issues identified. An administrator may reach out to you for clarification or to obtain additional information to aid us in continuously improving our services. This information will be kept confidential.

Name

City/Town

ZIP/Postal Code

Email Address

Phone Number