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Survey/Form Review
Health Department Customer Comment
1. What information or service were you seeking from the Health Department? Check all that apply.
Inspection (Type)
Permits (Type)
Other
2. Was the staff person(s) who helped you:
YesNo
Prompt
Courteous
Positive
Knowledgeable
Helpful
Respectful
3. How would you rate the overall service you received?
4. Did you understand the information provided by staff?
5. To help us provide the best possible customer service, please provide the name of the person(s) who assisted you.

6. What could we have done better to provide additional or improved service?

7. Do you have any additional comments, information, or suggestions?

8. If you would like to discuss your experience, please provide the following information:
Name/Organization
Address
City
Zip
Phone
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