Harrison County General Health District Client Satisfaction Survey

Dear Valued Client: The Harrison County General Health District cares about the quality of service you receive. Please take a moment to fill out this Client Satisfaction Survey to help us make any needed improvements and to recognize the programs you find satisfactory. Your opinions and suggestions are greatly appreciated. This evaluation will help us to serve you better.

If you have any questions about this survey, please contact Harrison County General Health District Administrator at 740-942-2616

Question Title

* 1. Date of Service (if you know it)

Date

Question Title

* 2. The main service I received was:

Birth or Death Certificate

Environmental Health Division (Septic, Water, Food)

Health Education Division (Silver Sneakers, Safe Sleep Program)

Nursing Division (Clinic, Immunizations)

WIC

Other (please specify)

Question Title

* 3. Tell us about your experience today.

	Good Experience	Average Experience	Poor Experience	N/A (I didn't have this type of experience)
Ability to get an appointment	Ability to get an appointment Good Experience	Ability to get an appointment Average Experience	Ability to get an appointment Poor Experience	Ability to get an appointment N/A (I didn't have this type of experience)
Comments (optional)
Hours health department is open	Hours health department is open Good Experience	Hours health department is open Average Experience	Hours health department is open Poor Experience	Hours health department is open N/A (I didn't have this type of experience)
Comments (optional)
Location is convenient	Location is convenient Good Experience	Location is convenient Average Experience	Location is convenient Poor Experience	Location is convenient N/A (I didn't have this type of experience)
Comments (optional)
My wait time was acceptable	My wait time was acceptable Good Experience	My wait time was acceptable Average Experience	My wait time was acceptable Poor Experience	My wait time was acceptable N/A (I didn't have this type of experience)
Comments (optional)
Staff: Friendly and helpful to you	Staff: Friendly and helpful to you Good Experience	Staff: Friendly and helpful to you Average Experience	Staff: Friendly and helpful to you Poor Experience	Staff: Friendly and helpful to you N/A (I didn't have this type of experience)
Comments (optional)
Staff: Answered all your questions	Staff: Answered all your questions Good Experience	Staff: Answered all your questions Average Experience	Staff: Answered all your questions Poor Experience	Staff: Answered all your questions N/A (I didn't have this type of experience)
Comments (optional)
Facility: Neat and clean building	Facility: Neat and clean building Good Experience	Facility: Neat and clean building Average Experience	Facility: Neat and clean building Poor Experience	Facility: Neat and clean building N/A (I didn't have this type of experience)
Comments (optional)
Facility: Comfortable and protects your privacy	Facility: Comfortable and protects your privacy Good Experience	Facility: Comfortable and protects your privacy Average Experience	Facility: Comfortable and protects your privacy Poor Experience	Facility: Comfortable and protects your privacy N/A (I didn't have this type of experience)
Comments (optional)
How would you rate your overall service?	How would you rate your overall service? Good Experience	How would you rate your overall service? Average Experience	How would you rate your overall service? Poor Experience	How would you rate your overall service? N/A (I didn't have this type of experience)
Comments (optional)

Question Title

* 4. Was this your first time receiving services from the Harrison County General Health District?

Yes

Not Sure

Question Title

* 5. Would you recommend the Harrison County General Health District to others?

Yes

Question Title

* 6. What could we have done better?

Question Title

* 7. If you were not happy with our services, may we contact you?

Yes

Please include your email and/or phone number: