What date did you receive service at or from the Union County Health Department:

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* 1. What date did you receive service at or from the Union County Health Department:

Date
What is your current city, village, township or zip code

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* 2. What is your current city, village, township or zip code

Select which services you received from the Union County Health Department (mark all that apply):

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* 3. Select which services you received from the Union County Health Department (mark all that apply):

Indicate your agreement with the following:

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* 4. Indicate your agreement with the following:

  Strongly Agree Agree Disagree Strongly Disagree N/A
The staff was helpful.
The hours of operation met my needs
The appointment process was handled in a timely manner.
The service provided was conducted in a professional manner. 
Overall, I was pleased with the quality of service
The fees were reasonable.
Please share any additional comments, suggestions or feedback about the service provided to you.

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* 5. Please share any additional comments, suggestions or feedback about the service provided to you.

Please indicate if any staff person was helpful to you during your visit and how they assisted you.

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* 6. Please indicate if any staff person was helpful to you during your visit and how they assisted you.

How did you hear about Union County Health Department Services? (Check all that apply)

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* 7. How did you hear about Union County Health Department Services? (Check all that apply)

I would like to be contacted about my service.  Please reach me at the following phone number or email address (include your name):

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* 8. I would like to be contacted about my service.  Please reach me at the following phone number or email address (include your name):

Your contact information is not required. If you prefer your ratings remain anonymous but still would like to contact UCHD, please call (937) 642-2053.

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