Customer Satisfaction Survey for Sandusky County Public Health (new version 02/2023)

Question Title

* 1. Date of appointment or service:

Please enter in a mm/dd/yyyy format.

Date

Question Title

* 2. What is your ZIP code?

43420 (Fremont)

43407 (Burgoon)

43410 (Clyde)

43431 (Gibsonburg)

43435 (Helena)

43442 (Lindsey)

43464 (Vickery)

43469 (Woodville)

44836 (Green Springs)

44841 (Kansas)

44811 (Bellevue)

43457 (Risingsun)

Other (please specify)

Question Title

* 3. What was the MAIN service or information you received from us on that day?

Birth and Death Records

Environmental Services (septic systems, wells, water samples, inspections, licensing, etc.)

Food Safety Inspections / Plans / Permits

Immunizations / Shots (including COVID vaccine)

Family Planning / Reproductive Health & Wellness

BCMH Program (Bureau for Children with Medical Handicaps)

Cribs for Kids (Infant Safe Sleep Program)

WIC (Women, Infants, and Children)

Help Me Grow

Health Education (bike helmet, Narcan kit, medication lock box, etc.)

Other (please specify)

Question Title

* 4. Tell us about your experience that day:

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
I was treated with courtesy and respect.	I was treated with courtesy and respect. Strongly Agree	I was treated with courtesy and respect. Agree	I was treated with courtesy and respect. Neutral	I was treated with courtesy and respect. Disagree	I was treated with courtesy and respect. Strongly Disagree
Staff was professional and knowledgeable.	Staff was professional and knowledgeable. Strongly Agree	Staff was professional and knowledgeable. Agree	Staff was professional and knowledgeable. Neutral	Staff was professional and knowledgeable. Disagree	Staff was professional and knowledgeable. Strongly Disagree
Services and/or information were received in a timely manner.	Services and/or information were received in a timely manner. Strongly Agree	Services and/or information were received in a timely manner. Agree	Services and/or information were received in a timely manner. Neutral	Services and/or information were received in a timely manner. Disagree	Services and/or information were received in a timely manner. Strongly Disagree
I was treated in a way that was respectful of my race/my ethnic background/my culture.	I was treated in a way that was respectful of my race/my ethnic background/my culture. Strongly Agree	I was treated in a way that was respectful of my race/my ethnic background/my culture. Agree	I was treated in a way that was respectful of my race/my ethnic background/my culture. Neutral	I was treated in a way that was respectful of my race/my ethnic background/my culture. Disagree	I was treated in a way that was respectful of my race/my ethnic background/my culture. Strongly Disagree
I felt the quality of services was excellent.	I felt the quality of services was excellent. Strongly Agree	I felt the quality of services was excellent. Agree	I felt the quality of services was excellent. Neutral	I felt the quality of services was excellent. Disagree	I felt the quality of services was excellent. Strongly Disagree

Question Title

* 5. How did you find out about the services offered at Sandusky County Public Health?

Friends/Family

Website

Radio

Doctor / Health Professional

Social Media (Facebook, Twitter, etc.)

Newspaper

I have received services or information in the past

Other (please specify)

Question Title

* 6. What is your race?

White

Black or African American

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Multi-racial

Another race

Other (please specify)

Question Title

* 7. Are you of Hispanic or Latino origin?

Yes

Question Title

* 8. What language(s) do you speak at home? (check all that apply)

English

Spanish

Arabic

Chinese

Japanese

Other (please specify)

Question Title

* 9. Any comments about your recent experience? If you would like to be contacted, please enter your name and contact information (phone or email). *Please allow 5 - 7 business days for a response.