Johnson County Public Health Customer Satisfaction Survey

Thank you for taking the time to participate in this survey. It is our mission to provide excellent customer service. Your feedback will assist us to evaluate our current performances as well as to identify future improvements.

The survey will take less than five minutes to complete.

Question Title

* Please select your reason for receiving information, support, and/or service with Johnson County Public Health (JCPH).

Question Title

* Rate your recent experience with JCPH:

	Excellent	Good	Average	Needs Improvement	Poor
Quality of information, support, and/or service	Quality of information, support, and/or service Excellent	Quality of information, support, and/or service Good	Quality of information, support, and/or service Average	Quality of information, support, and/or service Needs Improvement	Quality of information, support, and/or service Poor
Respectfulness of staff	Respectfulness of staff Excellent	Respectfulness of staff Good	Respectfulness of staff Average	Respectfulness of staff Needs Improvement	Respectfulness of staff Poor
Staff knowledge	Staff knowledge Excellent	Staff knowledge Good	Staff knowledge Average	Staff knowledge Needs Improvement	Staff knowledge Poor
Wait time for information, support, and/or service	Wait time for information, support, and/or service Excellent	Wait time for information, support, and/or service Good	Wait time for information, support, and/or service Average	Wait time for information, support, and/or service Needs Improvement	Wait time for information, support, and/or service Poor

Question Title

* How could we improve our information, support, and/or services for you?

If you would like a JCPH staff member to follow up with you about your input, please provide your contact information below.

Question Title

* Contact Information

Name

Phone Number