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Public Health Client Survey

The staff and administration of Kittitas County Health Department would appreciate your taking a few minutes to complete this evaluation. We are very interested in your comments on how we do our job, especially if you can offer suggestions for improvement. Thank you.

Please provide the following information:

Please identify the program area/staff member addressed in this survey: Other:
1.		Gender:
2.		Age:
3.		How did you hear about the service you used: Radio Newspaper Referral from another agency Permit required Phonebook Website Other - please explain

Based on your interaction with Health Department staff, please rate your level of satisfaction with our service in the following areas:		1 Poor	2 Fair	3 Good	4 Excellent	N/A cannot rate
4.	Friendliness and courtesies of the staff:
5	Ability of staff to put me at ease:
6.	Timeliness of service:
7.	Staff demonstrated understanding of my situation:
8.	Staff knowledge:
9.	Accurate and useful information made available to me:
10.	Options and alternatives were offered when possible:
11.	Staff professionalism:
12.	Reliability of service: (I received what was promised by HD staff)
13.	Consistency in application of rules, regulations and/or policies:
14.	Courtesy of the reception staff:
15.	Respectfulness of reception staff:
16.	My overall level of satisfaction with the Kittitas County Health Department:
17.	How would you rate the phone system:
18.	Utility of website (did you find the information you were looking for online?):

19. What did we do well?

20. What could we improve?

21. Do you have any other comments? If you wish for us to follow-up with you, please provide your name and phone number or email address.

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