Darke County Health Department Satisfaction Survey - Vital Statistics
We value your opinion on various aspects of our practice. Your responses are confidential and anonymous.
Sign in to Google to save your progress. Learn more
What is the date? *
MM
/
DD
/
YYYY
What services were provided by DCHD? *
Please rate your satisfaction of each of the following:
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
Not Applicable
Overall experience of your service
Price of service
Regulations/Rules
Courtesy of the staff
Promptness you were served
Name of individual you were working with *
What suggestions do you have for improvement? Do you have any additional comments?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy