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GRDHD Satisfaction Survey

About Your Visit

Please take a moment to answer a few questions about your experience with our practice. All feedback is completely anonymous and is used for the purposes of improving our services.

1. Please select your patient status:

What was the main purpose of your most recent visit or contact with the health department? (Please select one)

*This question is required.

What type of appointment? (select one)

Which home visiting program? (select one)

3. What type of Health Promotion service did you receive?

3. What type of records did you receive?

3. What department provided you services?

Please enter an 'other' value for this selection.

3. For the service you are rating today, which county of Green River District Health Department assisted you?

4. Please select your level of satisfaction on the following:

Space Cell	Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied	N/A
Appointment availability
Amount of time you waited to see your provider
Hours of operation
Office cleanliness
Office location
Staff was informed (knowledgeable)
Staff was friendly and polite
Staff was thorough and attentive