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

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

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

* 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.

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

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

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

* 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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