Please Review Our Services

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* 1. Date of Service

(enter approximate date if unknown)

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* 2. Department or Service Provided
(e.g. permits, birth certificate, WIC clinic, etc.)

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* 3. What was your overall satisfaction with the service you received?

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* 4. What could we have done to make your experience excellent?
Or, if your service was excellent, please let us know why:

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* 5. Did our facility (Richland Public Health building and/or rooms) meet your needs?

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* 6. Did any of the following negatively affect your ability to access our services? Select all that apply.

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* 7. Would you like someone here to contact you regarding your responses?

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