Environmental Health Services Client Survey
Please share with us how you think we are doing with our services. Your input is greatly appreciated!
1. Location of service: In Clinton In Gratiot In Montcalm 2. Date of service:
3. Time of appointment: AM PM 4. Length of wait: 0 - 15 min 16 - 30 min More than 30 min
7. Type of appointment: Scheduled Appointment Walk-in
8. How did you hear about our services? Friend or family member Phone book Have used services in the past Other - please specify below:
Other source:
9. Service provided today: Food service inspection or food license Septic or well permit Septic or well evaluation Vacant land evaluation Other - please specify below:
Other service:
Please rate the quality of our services in the following (Please provide comments at the end of the form.)
10. I am satisfied with the service I received today:
11. Receptionist treated me with respect and was helpful:
12. Receptionist was knowledgeable of services I requested:
13. Receptionist attended to me in a timely manner:
14. The person who delivered services to me was friendly and helpful:
15. The person delivered services to me in a timely manner:
16. The person who delivered services to me was capable and could answer my questions:
17. The health department hours of operation are convenient for me:
18. When calling the Health Department, I can reach the staff when I need to:
19. The Health Department office was easy for me to find:
20. Are you satisfied with the service you received today? If so, please indicate why. If not satisfied, please explain what we could have done to improve the services you received.
If you would like us to contact you regarding a concern you may have, please provide the following information:
Your Name: Phone: Email:
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