Customer/Client Satisfaction Survey
Customer satisfaction is important to us. Please complete this brief survey to help us improve our services.
Date service received *
MM
/
DD
/
YYYY
City you live in *
If outside of Cuyahoga County, please enter city name
Your answer
Zip code *
Your answer
How you found out about the services available at the Board of Health – please check all that apply
Type of service(s) you received – please check all that apply *
Required
Did you receive the services or written materials in the language you wanted?
If No, please list the language you wanted
Your answer
If any educational materials were provided to you, were they helpful and able to be used as future references?
If you attended a training class taught by our staff, did the speaker keep your attention and allow for questions?
Please rate the following *
Excellent
Very Good
Good
Fair
Poor
Overall experience
Courtesy and professionalism of the service
Timeliness of the service
Age
Gender
Race/Ethnicity – please check all that apply
Do you feel your race/ethnicity, values/beliefs, or sexual orientation affected how you were treated?
If yes, please explain
Your answer
Have you received service from CCBH in the past?
Your comments or suggestions about how we can improve our service
Your answer
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