Customer Service Satisfaction Survey 2021 1. Question Title * 1. Date of Service Date / Time Date OK Question Title * 2. What service(s) would you like to leave feedback for today? (check all that apply): Birth/Death Certificate Harvesters Community Health Assessment/Community Health Improvement Plan Environmental Health STD Services WIC Immunizations/TB Dental Services Community Development Programming and Relationship Building Data Collection and dissemination Reportable Condition and Outbreak Investigation Emergency Response Unknown OK NEXT