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Customer Satisfaction Survey
Overall, how satisfied are you with our service?
*
1
2
3
4
5
Where did you receive service?
*
Please Select
Clifton Springs Health Center
East DeKalb Health Center
North DeKalb Health Center
Richardson Health Center
T.O. Vinson Health Center
Mobile Outreach Event
Your Home
Your Business
Other
Other Location
What type of service did you receive?
*
Please Select
Clinical Service (Immunization, Family Planning, Medical Records, Travel Medicine, TB, Pregnancy Testing, HIV/STI, PREP/PEP, Health Check, Sports Physical)
Health Assessment and Promotion (Diabetes Prevention, Injury Prevention, Tobacco Use Prevention & Cessation)
Maternal & Child Health (Babies Can't Wait, Children 1st, Children's Medical Services, Early Hearing Detection & Intervention, MORE, WIC, Adolescent Health & Youth Development)
Vital Records (Birth Certificates & Death Certificates)
Environmental Health -Body Art, Hospitality, Lead Poisoning, Mosquito Control, Rodent Control & Septic Systems
Environmental Health -Food Safety
Environmental Health -Public Pools, Beaches & Spas
Oral Health
Other
Other service
How satisfied were you with each of the following:
*
Not Applicable
Very Dissatisfied
Dissatisfied
Satisfied
Very Satisfied
No Opinion
Friendliness of Staff
Call Center
Check-In Process
Wait Time
Quality of Service
How likely are you to continue to use our services?
*
Very unlikely
Unlikely
Likely
Very likely
No opinion
Do you want to add or suggest something?
Submit
Should be Empty: