Toe River Health District Client Satisfaction Survey

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* 1. Please select specific health department

Avery County Health Department

Mitchell County Health Department

Yancey County Health Department

Thank you for choosing our health department. In order to continuously improve our services, we ask that you complete the following survey. The responses you provide are confidential.

We thank you for your valuable feedback.

Instructions for Completing the Survey:
For each question please select the answer that best represents your response.

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* 2. Gender:

Male

Female

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* 3. Age:

18-24 years

25-39 years

40-64 years

65+ years

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* 4. Race:

White

African American

Hispanic or Latino

Asian

American Indian or Alaska Native

Other

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* 5. During your more recent visit, what program or service did you receive? (Please check all that apply)

Breast and Cervical Cancer Control Program (BCCCP) Services

Care Coordination for Children (CC4C)

Child Health

Environmental Health

Family Planning Services

General Health Services/Primary Care

Healthy Families America

Immunization

Lab

Pregnancy Care Management (OBCM)

Prenatal Services

STD/HIV

Women, Infants, and Children (WIC)

Other (please specify)

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* 6. Where did you learn about our available services?

Friend or family member

Health Department staff

Health Department brochure or flyer

Health Department website or Facebook

Health Department advertisement

Other (please specify)

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* 7. Please indicate if you agree or disagree with each of the following statements by selecting your response on the scale provided

	Strongly Disagree	Disagree	Somewhat Disagree	Not Applicable	Somewhat Agree	Agree	Stongly Agree
Staff were courteous on the phone	Staff were courteous on the phone Strongly Disagree	Staff were courteous on the phone Disagree	Staff were courteous on the phone Somewhat Disagree	Staff were courteous on the phone Not Applicable	Staff were courteous on the phone Somewhat Agree	Staff were courteous on the phone Agree	Staff were courteous on the phone Stongly Agree
Appointment was easily attainable	Appointment was easily attainable Strongly Disagree	Appointment was easily attainable Disagree	Appointment was easily attainable Somewhat Disagree	Appointment was easily attainable Not Applicable	Appointment was easily attainable Somewhat Agree	Appointment was easily attainable Agree	Appointment was easily attainable Stongly Agree
Staff were friendly and helpful	Staff were friendly and helpful Strongly Disagree	Staff were friendly and helpful Disagree	Staff were friendly and helpful Somewhat Disagree	Staff were friendly and helpful Not Applicable	Staff were friendly and helpful Somewhat Agree	Staff were friendly and helpful Agree	Staff were friendly and helpful Stongly Agree
Wait time for the service(s) I received was appropriate	Wait time for the service(s) I received was appropriate Strongly Disagree	Wait time for the service(s) I received was appropriate Disagree	Wait time for the service(s) I received was appropriate Somewhat Disagree	Wait time for the service(s) I received was appropriate Not Applicable	Wait time for the service(s) I received was appropriate Somewhat Agree	Wait time for the service(s) I received was appropriate Agree	Wait time for the service(s) I received was appropriate Stongly Agree
Staff took the time to listen to my concerns	Staff took the time to listen to my concerns Strongly Disagree	Staff took the time to listen to my concerns Disagree	Staff took the time to listen to my concerns Somewhat Disagree	Staff took the time to listen to my concerns Not Applicable	Staff took the time to listen to my concerns Somewhat Agree	Staff took the time to listen to my concerns Agree	Staff took the time to listen to my concerns Stongly Agree
I had enough privacy	I had enough privacy Strongly Disagree	I had enough privacy Disagree	I had enough privacy Somewhat Disagree	I had enough privacy Not Applicable	I had enough privacy Somewhat Agree	I had enough privacy Agree	I had enough privacy Stongly Agree
The services I received met my social, cultural, and/or special needs	The services I received met my social, cultural, and/or special needs Strongly Disagree	The services I received met my social, cultural, and/or special needs Disagree	The services I received met my social, cultural, and/or special needs Somewhat Disagree	The services I received met my social, cultural, and/or special needs Not Applicable	The services I received met my social, cultural, and/or special needs Somewhat Agree	The services I received met my social, cultural, and/or special needs Agree	The services I received met my social, cultural, and/or special needs Stongly Agree
Information was given in my spoken language	Information was given in my spoken language Strongly Disagree	Information was given in my spoken language Disagree	Information was given in my spoken language Somewhat Disagree	Information was given in my spoken language Not Applicable	Information was given in my spoken language Somewhat Agree	Information was given in my spoken language Agree	Information was given in my spoken language Stongly Agree
Service hours were convenient (Mon-Fri: 8:00am-4:30pm)	Service hours were convenient (Mon-Fri: 8:00am-4:30pm) Strongly Disagree	Service hours were convenient (Mon-Fri: 8:00am-4:30pm) Disagree	Service hours were convenient (Mon-Fri: 8:00am-4:30pm) Somewhat Disagree	Service hours were convenient (Mon-Fri: 8:00am-4:30pm) Not Applicable	Service hours were convenient (Mon-Fri: 8:00am-4:30pm) Somewhat Agree	Service hours were convenient (Mon-Fri: 8:00am-4:30pm) Agree	Service hours were convenient (Mon-Fri: 8:00am-4:30pm) Stongly Agree
I am satisfied with the service(s) I received	I am satisfied with the service(s) I received Strongly Disagree	I am satisfied with the service(s) I received Disagree	I am satisfied with the service(s) I received Somewhat Disagree	I am satisfied with the service(s) I received Not Applicable	I am satisfied with the service(s) I received Somewhat Agree	I am satisfied with the service(s) I received Agree	I am satisfied with the service(s) I received Stongly Agree
I would recommend the Health Department to others	I would recommend the Health Department to others Strongly Disagree	I would recommend the Health Department to others Disagree	I would recommend the Health Department to others Somewhat Disagree	I would recommend the Health Department to others Not Applicable	I would recommend the Health Department to others Somewhat Agree	I would recommend the Health Department to others Agree	I would recommend the Health Department to others Stongly Agree

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* 8. Did you receive information during your visit about other services for which you might be eligible?

Yes

Toe River Health District Client Satisfaction Survey

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* 1. Please select specific health department

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* 2. Gender:

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* 3. Age:

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* 4. Race:

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* 5. During your more recent visit, what program or service did you receive? (Please check all that apply)

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* 6. Where did you learn about our available services?

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* 7. Please indicate if you agree or disagree with each of the following statements by selecting your response on the scale provided

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* 8. Did you receive information during your visit about other services for which you might be eligible?

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* 9. Would you like to recognize a person who was especially helpful? If so, please indicate his/her name.

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* 10. What can we improve on? (Please be specific)