Richland Public Health Customer Satisfaction Survey Please Review Our Services Question Title * 1. Date of Service (enter approximate date if unknown) Date OK Question Title * 2. Department or Service Provided(e.g. permits, birth certificate, WIC clinic, etc.) OK Question Title * 3. What was your overall satisfaction with the service you received? Excellent Above Average Average Fair Poor Excellent Above Average Average Fair Poor OK Question Title * 4. What could we have done to make your experience excellent? Or, if your service was excellent, please let us know why: OK Question Title * 5. Did our facility (Richland Public Health building and/or rooms) meet your needs? Yes No Not Applicable If you answered "No" please tell us why: OK Question Title * 6. Did any of the following negatively affect your ability to access our services? Select all that apply. N/A - I had no trouble accessing services Transportation Language barrier Cost of service(s) Physical or other disability Other (please explain) OK Question Title * 7. Would you like someone here to contact you regarding your responses? Yes No OK NEXT