Customer Satisfaction Survey

We Want to Hear from You

Did we fully answer your question (or refer you to someone who could)?


Strongly Agree	Agree	Uncertain	Disagree	Strongly Disagree
Was the information useful to you?


Strongly Agree	Agree	Uncertain	Disagree	Strongly Disagree
Did you consider the response to be courteous?


Strongly Agree	Agree	Uncertain	Disagree	Strongly Disagree
Type of Communication (check all that apply)?


Web site	Email	Telephone	Mail	Meeting
Please select the name of the staff member who assisted you. (For multiple selections, use the Control key [Windows] or the Command key [Macintosh] when you click to select or de-select.)


Please list any other Department of Health contacts who assisted:


Comments:

Optional information
Name:


Email: Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.

May we contact you? Yes No
*To confirm this is a valid application, please enter the number in the box below:



Thank you for taking the time to complete this survey.

This page was last modified on: 08/30/2012 04:33:42