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Hearing, Vision, or Oral Health Evaluation

To help us serve you better, we are providing this evaluation for your input as we try to make the screening services run as smoothly as possible. 
1. Location being evaluated
Technician's Name (select all that apply)
2. Please check the service that was provided today (select all that apply).
3. Overall, I am satisfied with the service we received.
4. Did you encounter any problems scheduling screening services?
5. Did the flow of the screening services work well?
6. Was the Health Department staff pleasant and cooperative?
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