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Columbus Health Department Customer Satisfaction Survey

We want to give the best service possible and what you think is important to us!

Enter the date you received service at the Columbus Health Department:
-- mm/dd/yy

Enter your zip code:

Please enter your gender: Sex Male Female

Select your race/ethnicity:

Select which services you received from the Columbus Health Department that apply:

Alcohol and Drug
Hospice
Home care
Breast & Cervical Cancer
TB Clinic
Birth/Death certificate
Environmental
Rabies Shots
Prenatal Care
WIC
Dental
Food License
Immunization
Sexual Health Clinic

Describe the courtesy and helpfulness of the staff:

Describe the hours of operations:

Was the waiting time reasonable?

Did the phone service meet your needs?

Were your needs met?

Describe the overall quality of service.

Would you recommend the Columbus Health Department to friends/relatives?

Would you come back to the Columbus Health Department for help again?

How did you hear about Columbus Health Department Services?

Friend/family
Pamphlet
Phone Book
Newspaper
TV/Radio
Other
Agency/referral
Doctor/Dentist

If you could change anything about the Columbus Health Department, what would it be?


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