English Español Français English Customer Complaint Survey We take customer feedback very seriously, and while we do not want our customers to have a less than satisfactory visit, we value your feedback. Please complete the following survey to tell us more about your recent visit. All items below are optional, however the more you tell us the better we can work to resolve the issue. Question Title * 1. Date that the problem or issues occurred. . Question Title * 2. With which department or clinic did you have the problem or issue? Area 7 Bellies’, Babies and Beyond Call Center Chronic Disease Dental Environmental Public Health Epidemiology Family Planning and Prenatal Health Front Desk Immunizations Medical Records NCF Phone Call School Health Sexually Transmitted Disease Sunshine Care Center Tuberculosis Services Violence & Injury Prevention Vital Statistics WIC Other (please specify) Question Title * 3. What was the location? Apopka Central Colonial High School Eastside Executive Center Hiawassee Elementary School Hoffner – WIC Hoffner Dental Lake Ellenor (Southside) Lila Mitchell Metrowest Mobile – Dental NCF Bithlo NCF Englewood NCF Pine Hills NCF Taft NCF Union Park Ocoee Robinswood Middle School Winter Garden Other (please specify) Question Title * 4. Complaint: Billing issues Difficulty reaching someone by phone Failure to provide timely responses to requests for information Lack of appointments Lack of knowledge Lack of personal attention Long wait times Poor follow-ups Poor response to inquiries Rude staff Slow service Unclear communication Unclear or confusing application processes Unhelpful staff Unprofessional or unfriendly staff Question Title * 5. Please tell us more about the issue or problem. Question Title * 6. Provide us with your contact information so we can talk to you about the problem or issue.Please note that we cannot email you about the issue/problem due to security requirements. Name - first and last Phone number Done
