CCPHD Customer/Community Feedback

Thank you for visiting the Chatham County Public Health Department! We are grateful that you chose to utilize our services. As part of our efforts to improve and better serve clients, we would love for you to fill out the survey below with your honest feedback.

1. Which of the following best describes the program/service you received or are interested in?

Clinical Services: Immunizations, Childbirth Classes, Communicable Disease, Breast & Cervical Cancer Control Program (BCCCP), Nutrition, Diabetes, Family Planning, Sexually-transmitted Infection Testing, Car Seats, Newborn Home Visiting Services, Parent Navigator Program, and Public Health Social Workers
Environmental Health: Wastewater & Septic Permits; Well Water Permits and Sampling; Food, lodging, & Institutions Inspections; Other Monitoring and Inspections; Lead Poisoning Prevention; Asthma Intervention
Health Education and Outreach: Child Care Health Consultant, Data and Communications, Public Presentations, Outreach Event, Community Education, Youth Health, Tobacco Use Prevention and Cessation, Opioid Overdose Prevention, Focus on Fathers
Vital Records: Birth and death certificates

2. Where did you hear about this service?

Please enter an 'other' value for this selection.

3. Before or during your appointment, were you made aware that our services are confidential?

3. Please tell us how strongly you agree or disagree with each statement below by checking the appropriate box.

Space Cell	Strongly Agree	Agree	Don't Know or N/A	Disagree	Strongly Disagree
It was easy to make an appointment.	It was easy to make an appointment.: Strongly Agree	It was easy to make an appointment.: Agree	It was easy to make an appointment.: Don't Know or N/A	It was easy to make an appointment.: Disagree	It was easy to make an appointment.: Strongly Disagree
I was able to get the services I needed.	I was able to get the services I needed.: Strongly Agree	I was able to get the services I needed.: Agree	I was able to get the services I needed.: Don't Know or N/A	I was able to get the services I needed.: Disagree	I was able to get the services I needed.: Strongly Disagree
I am satisfied with the services I received.	I am satisfied with the services I received.: Strongly Agree	I am satisfied with the services I received.: Agree	I am satisfied with the services I received.: Don't Know or N/A	I am satisfied with the services I received.: Disagree	I am satisfied with the services I received.: Strongly Disagree
Services were provided in a timely manner.	Services were provided in a timely manner.: Strongly Agree	Services were provided in a timely manner.: Agree	Services were provided in a timely manner.: Don't Know or N/A	Services were provided in a timely manner.: Disagree	Services were provided in a timely manner.: Strongly Disagree
The hours of operation met my needs.	The hours of operation met my needs.: Strongly Agree	The hours of operation met my needs.: Agree	The hours of operation met my needs.: Don't Know or N/A	The hours of operation met my needs.: Disagree	The hours of operation met my needs.: Strongly Disagree
I was treated with respect.	I was treated with respect.: Strongly Agree	I was treated with respect.: Agree	I was treated with respect.: Don't Know or N/A	I was treated with respect.: Disagree	I was treated with respect.: Strongly Disagree
I would recommend your services to others.	I would recommend your services to others.: Strongly Agree	I would recommend your services to others.: Agree	I would recommend your services to others.: Don't Know or N/A	I would recommend your services to others.: Disagree	I would recommend your services to others.: Strongly Disagree

4. What recommendations do you suggest for us to improve our services for you?

5. Please add any additional comments here:

6. If you would like someone to contact you to speak more about your experience, please write you name and phone number. This is not a required part of the form.

Name
Phone Number

CCPHD Customer/Community Feedback

Chatham County Public Health Department Customer/Community Feedback Card