Huron County Public Health (HCPH) Customer Satisfaction Survey Question Title * 1. Date of Service: Date: Date Question Title * 2. What service(s) did you receive? (check all that apply) Birth/Death Certificate Birth Control/Reproductive Health Car Seat Check Communicable Disease Follow-up Doctor Visit Food Inspection/Complaint Health Education Immunization (shots) Nuisance Complaint (Trash, Rodents, other) School Nursing Sewage Inspection/Complaint Other (please specify) Question Title * 3. Please rate your level of agreement with the following statements: Strongly Agree Agree Neither Agree nor disagree Disagree Strongly disagree I received the information or service that I needed I received the information or service that I needed Strongly Agree I received the information or service that I needed Agree I received the information or service that I needed Neither Agree nor disagree I received the information or service that I needed Disagree I received the information or service that I needed Strongly disagree I was served in a timely manner I was served in a timely manner Strongly Agree I was served in a timely manner Agree I was served in a timely manner Neither Agree nor disagree I was served in a timely manner Disagree I was served in a timely manner Strongly disagree I was treated with courtesy and respect I was treated with courtesy and respect Strongly Agree I was treated with courtesy and respect Agree I was treated with courtesy and respect Neither Agree nor disagree I was treated with courtesy and respect Disagree I was treated with courtesy and respect Strongly disagree Staff was knowledgeable & easy to understand Staff was knowledgeable & easy to understand Strongly Agree Staff was knowledgeable & easy to understand Agree Staff was knowledgeable & easy to understand Neither Agree nor disagree Staff was knowledgeable & easy to understand Disagree Staff was knowledgeable & easy to understand Strongly disagree Question Title * 4. What was your Overall Satisfaction with the service(s) received. Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Question Title * 5. How did you hear about HCPH? (Choose all that apply) HCPH Website HCPH Facebook Doctor Flier/pamphlet Online search Newspaper Friends/Family Returning Client Other (please specify) Question Title * 6. How can HCPH improve its service(s)? Done