Grundy County Health Department Client Satisfaction Survey
Please answer the following questions about your recent visit to the Grundy County Health Department. Leave your name, email and phone number if you'd like to be entered in our monthly drawing.
Date of Service
MM
/
DD
/
YYYY
Are you a Grundy County Resident?
What service did you receive?
How would you rate the friendliness of the GCHD staff?
Was the staff courteous and respectful? Were your questions answered?
Not friendly
Very friendly
How would you rate the GCHD facility?
Was the facility clean and welcoming? Was everything in working order? Were the restrooms clean?
Unsatisfactory
Excellent
How would you rate the quality of the service you received?
Was the staff knowledgeable and professional?
Unsatisfactory
Excellent
How would you rate the efficiency of the service you received?
Were you greeted quickly? Did you wait long for service?
Not efficient
Very efficient
We welcome your comments!
Your answer
Would you like to be entered in our quarterly drawing?
Next
Never submit passwords through Google Forms.
This form was created inside of Grundy County Health Department. Report Abuse - Terms of Service - Additional Terms