Crawford County Public Health1520 Isaac Beal Rd., Bucyrus, OH 44820419-562-5871 Survey

Please take a few minutes to fill out this survey on the quality of the service you received today. Crawford County Public Health welcomes your feedback and your answers will be kept confidential. Thank you for your participation.

	Strongly Disagree	Disagree	Agree	Strongly Agree	N/A
My request was responded to promptly.	My request was responded to promptly. Strongly Disagree	My request was responded to promptly. Disagree	My request was responded to promptly. Agree	My request was responded to promptly. Strongly Agree	My request was responded to promptly. N/A
Staff conducted themselves in a professional manner.	Staff conducted themselves in a professional manner. Strongly Disagree	Staff conducted themselves in a professional manner. Disagree	Staff conducted themselves in a professional manner. Agree	Staff conducted themselves in a professional manner. Strongly Agree	Staff conducted themselves in a professional manner. N/A
Staff members were friendly.	Staff members were friendly. Strongly Disagree	Staff members were friendly. Disagree	Staff members were friendly. Agree	Staff members were friendly. Strongly Agree	Staff members were friendly. N/A
I was treated with courtesy and respect.	I was treated with courtesy and respect. Strongly Disagree	I was treated with courtesy and respect. Disagree	I was treated with courtesy and respect. Agree	I was treated with courtesy and respect. Strongly Agree	I was treated with courtesy and respect. N/A
The information I received was easy to understand.	The information I received was easy to understand. Strongly Disagree	The information I received was easy to understand. Disagree	The information I received was easy to understand. Agree	The information I received was easy to understand. Strongly Agree	The information I received was easy to understand. N/A
Staff listened to my concerns.	Staff listened to my concerns. Strongly Disagree	Staff listened to my concerns. Disagree	Staff listened to my concerns. Agree	Staff listened to my concerns. Strongly Agree	Staff listened to my concerns. N/A
Staff answered my questions or referred me to someone who could.	Staff answered my questions or referred me to someone who could. Strongly Disagree	Staff answered my questions or referred me to someone who could. Disagree	Staff answered my questions or referred me to someone who could. Agree	Staff answered my questions or referred me to someone who could. Strongly Agree	Staff answered my questions or referred me to someone who could. N/A
I was provided clear instructions on follow-up steps.	I was provided clear instructions on follow-up steps. Strongly Disagree	I was provided clear instructions on follow-up steps. Disagree	I was provided clear instructions on follow-up steps. Agree	I was provided clear instructions on follow-up steps. Strongly Agree	I was provided clear instructions on follow-up steps. N/A
The service provided to me was delivered at the agreed upon date.	The service provided to me was delivered at the agreed upon date. Strongly Disagree	The service provided to me was delivered at the agreed upon date. Disagree	The service provided to me was delivered at the agreed upon date. Agree	The service provided to me was delivered at the agreed upon date. Strongly Agree	The service provided to me was delivered at the agreed upon date. N/A
Overall, I am satisfied with the services provided.	Overall, I am satisfied with the services provided. Strongly Disagree	Overall, I am satisfied with the services provided. Disagree	Overall, I am satisfied with the services provided. Agree	Overall, I am satisfied with the services provided. Strongly Agree	Overall, I am satisfied with the services provided. N/A

Strongly Disagree

Disagree

Agree

Strongly Agree

N/A

My request was responded to promptly.

My request was responded to promptly. Strongly Disagree

My request was responded to promptly. Disagree

My request was responded to promptly. Agree

My request was responded to promptly. Strongly Agree

My request was responded to promptly. N/A

Staff conducted themselves in a professional manner.

Staff conducted themselves in a professional manner. Strongly Disagree

Staff conducted themselves in a professional manner. Disagree

Staff conducted themselves in a professional manner. Agree

Staff conducted themselves in a professional manner. Strongly Agree

Staff conducted themselves in a professional manner. N/A

Staff members were friendly.

Staff members were friendly. Strongly Disagree

Staff members were friendly. Disagree

Staff members were friendly. Agree

Staff members were friendly. Strongly Agree

Staff members were friendly. N/A

I was treated with courtesy and respect.

I was treated with courtesy and respect. Strongly Disagree

I was treated with courtesy and respect. Disagree

I was treated with courtesy and respect. Agree

I was treated with courtesy and respect. Strongly Agree

I was treated with courtesy and respect. N/A

The information I received was easy to understand.

The information I received was easy to understand. Strongly Disagree

The information I received was easy to understand. Disagree

The information I received was easy to understand. Agree

The information I received was easy to understand. Strongly Agree

The information I received was easy to understand. N/A

Staff listened to my concerns.

Staff listened to my concerns. Strongly Disagree

Staff listened to my concerns. Disagree

Staff listened to my concerns. Agree

Staff listened to my concerns. Strongly Agree

Staff listened to my concerns. N/A

Staff answered my questions or referred me to someone who could.

Staff answered my questions or referred me to someone who could. Strongly Disagree

Staff answered my questions or referred me to someone who could. Disagree

Staff answered my questions or referred me to someone who could. Agree

Staff answered my questions or referred me to someone who could. Strongly Agree

Staff answered my questions or referred me to someone who could. N/A

I was provided clear instructions on follow-up steps.

I was provided clear instructions on follow-up steps. Strongly Disagree

I was provided clear instructions on follow-up steps. Disagree

I was provided clear instructions on follow-up steps. Agree

I was provided clear instructions on follow-up steps. Strongly Agree

I was provided clear instructions on follow-up steps. N/A

The service provided to me was delivered at the agreed upon date.

The service provided to me was delivered at the agreed upon date. Strongly Disagree

The service provided to me was delivered at the agreed upon date. Disagree

The service provided to me was delivered at the agreed upon date. Agree

The service provided to me was delivered at the agreed upon date. Strongly Agree

The service provided to me was delivered at the agreed upon date. N/A

Overall, I am satisfied with the services provided.

Overall, I am satisfied with the services provided. Strongly Disagree

Overall, I am satisfied with the services provided. Disagree

Overall, I am satisfied with the services provided. Agree

Overall, I am satisfied with the services provided. Strongly Agree

Overall, I am satisfied with the services provided. N/A

Crawford County Public Health
1520 Isaac Beal Rd., Bucyrus, OH 44820
419-562-5871

Customer Satisfaction Survey

Question Title

1. What service(s) did you receive? Select all that apply.

Question Title

2. What is the current age of the client that received service(s)?

Question Title

3. Select the answer that best describes your experience(s) at the extent to which you agree or disagree to the following statements.

Question Title

4. How can we better serve you and the community?

Question Title

5. What makes it difficult to use our services?

Question Title

6. Other comments (please comment on any ratings, "neutral", "disagree", or "strongly disagree")

Question Title

7. If you would like to further discuss your experience with the Division Administrator, please provide your email and/or phone number below.