2015 Public Input Survey

The purpose of this survey is intended to find out how often county residents utilize the Franklin County Health Department's services and to help us improve when, how, and what services we offer.

Question Title

* 1. Please check the area(s) in which you received service:

Infant and Child Health

Immunizations (Childhood and Adult)

Pregnancy Care Management

Maternal Health

Community Care 4 Children (CC4C)

Women, Infant and Children (WIC)

Family Planning

Adult Health

Communicable Disease Control (STD, Turberculosis (TB))

Health Education/ Health Promotion

Laboratory Services

Dental Clinic

Question Title

* 2. How often do you visit or use the health department?

At least once per year

Every other year or two

I have not used Franklin County Health Department in over 3 years

I have never used Franklin County Health Department

Question Title

* 3. When answering the above question, if you checked that you have not used Franklin County Health Department in 3 or more years, or that you have never used the health department services, please tell us why by selecting from the answers below. You may choose multiple answers.

I have not used Franklin County Health Department because I have another doctor

I have used Franklin County Health Department before, but I was not happy about the services that I received

I have not heard good things about Franklin County Health Department

I have not heard anything about Franklin County Health Department

Question Title

* 4. Which of the following best describes your racial or ethnic background?

Black

White

Asian

Hispanic

American Indian

Other

Question Title

* 5. What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

Other (please specify)

Question Title

* 6. What are some things that would make you more likely to visit the Franklin County Health Department?

Receiving more information about the services the health department offers

Same-day "call-in" appointments

Extended hours

Nothing

I think the health department should offer:

Question Title

* 7. Franklin County Health Department is open from 8:00am- 5:00pm. How do you feel about the hours of operation?

These hours are just right

Franklin County Health Department should be open earlier than 8:00am

Franklin County Health Department should be open later than 5:00pm

There should be extended hours at least once per week

Question Title

* 8. If Franklin County Health Department could use social networking services to provide you with news/information, which would you use?

Facebook

Linked In

Google Plus+

Twitter

Question Title

* 9. Thinking of your visit how would you rate the following?

	Poor	Fair	Good	Excellent
Privacy Provided	Privacy Provided Poor	Privacy Provided Fair	Privacy Provided Good	Privacy Provided Excellent
Length of Wait Time	Length of Wait Time Poor	Length of Wait Time Fair	Length of Wait Time Good	Length of Wait Time Excellent
Quality of Care Provided	Quality of Care Provided Poor	Quality of Care Provided Fair	Quality of Care Provided Good	Quality of Care Provided Excellent
Cleanliness of the Health Department	Cleanliness of the Health Department Poor	Cleanliness of the Health Department Fair	Cleanliness of the Health Department Good	Cleanliness of the Health Department Excellent
Bulletin Board/Educational Displays	Bulletin Board/Educational Displays Poor	Bulletin Board/Educational Displays Fair	Bulletin Board/Educational Displays Good	Bulletin Board/Educational Displays Excellent
Directional Signs in the Building	Directional Signs in the Building Poor	Directional Signs in the Building Fair	Directional Signs in the Building Good	Directional Signs in the Building Excellent

Question Title

* 10. Would you be willing to help Franklin County Health Department find ways to spread the word about the services or to improve services provided? If yes, please write your name and telephone number.

Name:

Phone Number: