HEALTH DEPARTMENTS

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HEALTH TIP

Buy low-fat yogurt, fruit juice, and fresh, canned, or frozen fruit to blend a quick fruit smoothie. Get juicy! Buy 100 percent fruit or vegetable juice to quench your thirst and satisfy one serving of fruits and vegetables.

Customer Service Questionnaire

What health dept, clinic, or office did you visit?


What was the purpose of your visit?


Was your wait time acceptable?
(if no, please note why in comment box)

Did you receive friendly and well-organized customer service?
(if no, please note why in comment box)

In the past 12 months, how many times have you visited a public health facility?

Please rate your overall experience:
(1 being unsatisfied, 10 being completely satisfied)

Comment Box (please include all suggestions, comments or complaints):


May we contact you? If so, please provide the following:

Your Name:   
Phone Number:    -
Email Address: