Community & Customer Satisfaction Survey
We would love to hear your thoughts or feedback on how we can improve your experience!
Do you live in Polk County?
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Yes
No
Have you requested services from Polk County Public Health Division since July 1, 2019?
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Yes
No
Which service(s) were you requesting? (Check all that apply)
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Vital Records (Birth or death certificates)
WIC (Women, Infants and Children Supplemental Nutrition Program
Communicable Disease Control
Environmental Health
Clinic Services
Not applicable/have not requested services
Other
Did you encounter any problems, and were those problems resolved?
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There were no problems
Problems encountered and staff resolved them
Problems encountered but are being resolved
Problems encountered and are not being resolved
The health department is open Monday-Friday from 8:30 am to 5:00 pm. Are these hours of operation sufficient to meet the needs of our community?
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Yes
No
If these hours of operation are not sufficient to meet the needs of the community, please comment below:
Overall, how would you rate the quality of your customer service experience with the Polk County Public Health Division?
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Very positive
Somewhat positive
Neutral
Somewhat negative
Very negative
How would you rate the overall quality of public health services that are available to the public in Polk County?
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Excellent
Very good
Good
Fair
Poor
Other Comments
Suggestions for Improvement
Name (Optional)
First Name
Last Name
Email (Optional)
example@example.com
Phone (Optional)
Please enter a valid phone number.
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