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Home » Contact Us » Customer Satisfaction Survey

CUSTOMER SATISFACTION SURVEY


 2     Kent City Health Department 
     414 East Main Street
     Kent, Ohio 44240                           
 
    
 
       

 

 Customer Satisfaction Survey 
              
How can we improve?             
 
Please take a moment to help us improve your experience at the Kent City Health Department. 
 
  Are you a Kent, Ohio Resident?   YES     NO

  Date of Service:  
  
     Month / Day / Year (numeric)

  Please mark the type of service utilized:  
       Vital Statistics
       Childhood Immunizations
       Complaint Investigation
       Environmental Health (Please check which program):
             Housing    Food Safety    Swimming Pools & Spa    Animal Bites    Tattoos & Body Piercing 
        Other- Please List:
           
     

  Please mark the quality of service you received:  
       Excellent
       Good
       Average
       Needs Improvement
       Poor

  Please mark the box that best describes our level of service:                                                
   Excellent    Good     Average    Needs
  Improvement  
 N/A      
 Courtesy of Staff                       
 Office Hours    
  
     
 Wait Time    
  
      
 Phone Service   
        
 Facility      
  
     
                                                                                                         
  Please mark which other services you would like us to provide: 
        Travel Immunizations
        Primary Care  
        
Chronic Disease Education
        
Smoking Cessation Program
        Maternal and Child Health
         Other- Please List:
            

  Comments:
     
         

     
     
              Thank you for your participation!


                

Joan C. Seidel MA, BSN, RN, CIC, FAPIC Kent City Health Commissioner

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