North Central Health District Customer Satisfaction Survey
Share your feedback about our public health services. This survey is anonymous unless you voluntarily provide contact information at the end of this survey.
Where did you visit to receive services?
*
Please Select
Baldwin County Health Department
Crawford County Health Department
Hancock County Health Department
Houston County Health Department
Jasper County Health Department
Jones County Health Department
Macon-Bibb County Health Department
Monroe County Health Department
Peach County Health Department
Putnam County Health Department
Twiggs County Health Department
Washington County Health Department
Wilkinson County Health Department
HOPE Center
Houston County Family Advocacy WIC Office
Macon-Bibb County Felton Homes WIC Office
North Central Health District Main Office
Houston County Lindsey Center
Off-Site Location or Event (please describe)
Home visit service (please describe)
What type of service did you use during your visit? (choose all that apply)
*
Clinical (vaccination, screening, testing, etc.)
Environmental Health (inspections, permits, etc.)
WIC (nutrition certification, breastfeeding, farmers market, etc.)
Other
Which HOPE Center services did you receive this visit? (choose all that apply)
*
Clinical Services
Case Management
Housing
Lab
Pharmacy
Transportation
Other
Please provide information about the off-site location/event:
*
Please provide information about your home visit:
*
How easy was it to access our public health services?
*
Easy
Somewhat easy
Somewhat difficult
Difficult
Please select any difficulties with accessing our services: (choose all that apply)
Location/Distance to the health department
Operating hours (for example, closed on weekends, no evening hours)
Long wait times (either on the phone or in person)
Lack of information on how to receive care
Transportation issues
Other
Please include any additional information you would like to share about difficulties with access:
Did you schedule an appointment, or was your visit a walk-in?
*
I scheduled an appointment
I visited as a walk-in
Was it easy to schedule an appointment?
*
Yes
No
Were there any difficulties with scheduling an appointment?
How long was your wait time before receiving services?
Please provide wait time in minutes
How well did our staff communicate with you during your visit?
*
Excellent
Good
Fair
Poor
Did you feel respected and treated with courtesy during your visit?
*
Always
Most of the time
Sometimes
Rarely
Never
How did you hear about our services? (choose all that apply)
*
TV
Radio
Newspaper
Online ad
Website
Social media
Word of mouth
Referral
Other
How satisfied are you with your visit overall?
*
1
2
3
4
5
Would you visit the same public health location in the future?
Yes
No
If not, please let us know what would bring you back.
If you would like to share any additional details about your visit, please include here:
Would you like someone from North Central Health District to contact you about your visit?
*
Yes, I will provide my contact information
No, I would like to remain anonymous
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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