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KRDHD Client Satisfaction Survey

Please help us improve our services to you and the community by taking this short survey. For each question please select the answer that best represents your response. Thank you!

1. Where did you receive your service?

2. Which program/service did you receive? (check all that apply)

3. How much do you agree with the following statements?

Space Cell	Strongly Agree	Agree	Neither Agree or Disagree	Disagree	Strongly Disagree	N/A
The appointment time worked with my schedule.	The appointment time worked with my schedule. : Strongly Agree	The appointment time worked with my schedule. : Agree	The appointment time worked with my schedule. : Neither Agree or Disagree	The appointment time worked with my schedule. : Disagree	The appointment time worked with my schedule. : Strongly Disagree	The appointment time worked with my schedule. : N/A
Health Department staff were friendly and respectful.	Health Department staff were friendly and respectful.: Strongly Agree	Health Department staff were friendly and respectful.: Agree	Health Department staff were friendly and respectful.: Neither Agree or Disagree	Health Department staff were friendly and respectful.: Disagree	Health Department staff were friendly and respectful.: Strongly Disagree	Health Department staff were friendly and respectful.: N/A
The services I received were delivered promptly.	The services I received were delivered promptly.: Strongly Agree	The services I received were delivered promptly.: Agree	The services I received were delivered promptly.: Neither Agree or Disagree	The services I received were delivered promptly.: Disagree	The services I received were delivered promptly.: Strongly Disagree	The services I received were delivered promptly.: N/A
Health department staff were helpful.	Health department staff were helpful.: Strongly Agree	Health department staff were helpful.: Agree	Health department staff were helpful.: Neither Agree or Disagree	Health department staff were helpful.: Disagree	Health department staff were helpful.: Strongly Disagree	Health department staff were helpful.: N/A
Information provided was clear/understandable.	Information provided was clear/understandable.: Strongly Agree	Information provided was clear/understandable.: Agree	Information provided was clear/understandable.: Neither Agree or Disagree	Information provided was clear/understandable.: Disagree	Information provided was clear/understandable.: Strongly Disagree	Information provided was clear/understandable.: N/A
Staff was well informed.	Staff was well informed.: Strongly Agree	Staff was well informed.: Agree	Staff was well informed.: Neither Agree or Disagree	Staff was well informed.: Disagree	Staff was well informed.: Strongly Disagree	Staff was well informed.: N/A
The services I received met my social, cultural, and/or special needs.	The services I received met my social, cultural, and/or special needs. : Strongly Agree	The services I received met my social, cultural, and/or special needs. : Agree	The services I received met my social, cultural, and/or special needs. : Neither Agree or Disagree	The services I received met my social, cultural, and/or special needs. : Disagree	The services I received met my social, cultural, and/or special needs. : Strongly Disagree	The services I received met my social, cultural, and/or special needs. : N/A
Health department staff took the time to listen to my concerns.	Health department staff took the time to listen to my concerns.: Strongly Agree	Health department staff took the time to listen to my concerns.: Agree	Health department staff took the time to listen to my concerns.: Neither Agree or Disagree	Health department staff took the time to listen to my concerns.: Disagree	Health department staff took the time to listen to my concerns.: Strongly Disagree	Health department staff took the time to listen to my concerns.: N/A
If visit occurred in a health department facility it was clean and free from safety concerns.	If visit occurred in a health department facility it was clean and free from safety concerns.: Strongly Agree	If visit occurred in a health department facility it was clean and free from safety concerns.: Agree	If visit occurred in a health department facility it was clean and free from safety concerns.: Neither Agree or Disagree	If visit occurred in a health department facility it was clean and free from safety concerns.: Disagree	If visit occurred in a health department facility it was clean and free from safety concerns.: Strongly Disagree	If visit occurred in a health department facility it was clean and free from safety concerns.: N/A
I got the information or service that I needed.	I got the information or service that I needed. : Strongly Agree	I got the information or service that I needed. : Agree	I got the information or service that I needed. : Neither Agree or Disagree	I got the information or service that I needed. : Disagree	I got the information or service that I needed. : Strongly Disagree	I got the information or service that I needed. : N/A
I would recommend the program/service to my friends and family.	I would recommend the program/service to my friends and family.: Strongly Agree	I would recommend the program/service to my friends and family.: Agree	I would recommend the program/service to my friends and family.: Neither Agree or Disagree	I would recommend the program/service to my friends and family.: Disagree	I would recommend the program/service to my friends and family.: Strongly Disagree	I would recommend the program/service to my friends and family.: N/A

4. If you answered strongly disagree or disagree to at least one of the statements, please explain why.

4. How satisfied were you with your overall experience?

Very Satisfied	Satisfied	Neutral	Dissatisfied	Very Dissatisfied
Very Satisfied	Satisfied	Neutral	Dissatisfied	Very Dissatisfied

5. Did anyone provide outstanding service? If so, who and what they did that made the service outstanding.

6. What did we do well?

7. What could we do better? (Please be specific)

8. How did you hear about our services?

Please enter an 'other' value for this selection.

9. Would you like to be contacted by a staff member to discuss your responses?

10. If yes, please list your name and contact information.

Name
Phone Number
Email